Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion

Chen, Qiang; Cao, Hua; Zhang, Gui-Can; Chen, Dao-zhong

doi:10.1016/j.ejcts.2011.04.001

Cited by 19 publications

(43 citation statements)

References 23 publications

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“…Many reports have described the similarities in the complications and long-term prognosis after atrial septal Amplatzer occlusion, interventional occlusion, and surgical occlusion (22)(23)(24); therefore, we have not discussed these details in the present report. Our patients were followed up for 2 years, and no significant adverse events occurred, which is consistent with other studies.…”

Section: Discussionmentioning

confidence: 83%

Percutaneous occluder device closure through femoral vein guidance by transthoracic echocardiography in adult atrial septal defect patients

Jia

et al. 2018

J. Thorac. Dis.

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Background: This study aimed to summarize percutaneous occluder device closure of atrial septal defects (ASD) through the femoral vein, using guidance by transthoracic echocardiography under local anesthesia without radiation or fluoroscopic guidance.Methods: This was a case series of fourteen patients, 3 males and 11 females, diagnosed with central ASD, the diameter of the defect ranged from 9 to 32 mm, and the patients had no other heart malformations or organ dysfunction. The patients underwent a novel surgical technique of occluder device closure for ASD. The occluder closure procedures were completed through puncture of the femoral vein, and fluoroscopyfree catheter guidance by transthoracic echography without radiation. Results: All of the cases had successful closure of the ASD, without residual shunt or complications. The median operation time was 18.7±22.5 min (range, 12-56 min), with no ICU-stay time and a short hospital stay of 2.3±0.5 days (range, 1-3 days). All patients were followed up for 2 years and there were no cases of residual shunt. All occluders remained in place. Conclusions: Percutaneous occluder device closure of ASDs through the femoral vein with fluoroscopyfree guidance by transthoracic echography without radiation under local anesthesia could be an easy choice for some simple ASD patients, and may also be favored by cardiac surgeons. real-time three-dimensional imaging, alongside technical modifications, and newer concepts for hemodynamic evaluation interventional occlusion has become popular in the pediatric population (2), and now is becoming of interest in adults (3). These improved imaging methods provide high quality imaging allowing accurate anatomical measurement of the maximum defect size, the morphology of the surrounding rim, and allows evaluation of the relationship between the device and septal rim (2). In this study we used transthoracic echocardiography guidance which has been shown to be safe, effective, and easy during transcatheter ASD closure (4). The novelty of this study is that there was also no need for fluoroscopic guidance during the ASD closure.In the present study of patients with simple, centrally located ASDs, we combined the characteristics of interventional and surgical repair using an ASD occluder through femoral vein puncture guided by transthoracic ultrasonography without radiation under local anesthesia. The information we provide should assist clinicians who select a similar method for treatment of simple ASDs. Methods Patient selectionFrom May 2014 to July 2016, 14 patients underwent percutaneous occluder device closure through femoral vein guiding by transthoracic echography in the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University. To be eligible for inclusion in the case series the criteria were: (I) aged 18 and over; (II) a secundum ASD (central type) and left-to-right shunt; (III) the diameter of the defect <38 mm; (IV) grade I cardiac function; (V) no or mild tricuspid regurgitation, no right ventricular volume ...

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Section: Discussionmentioning

confidence: 83%

Percutaneous occluder device closure through femoral vein guidance by transthoracic echocardiography in adult atrial septal defect patients

Jia

et al. 2018

J. Thorac. Dis.

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“…Meanwhile, another study also confirmed the safety and efficacy of transthoracic echocardiographic guidance of ASD device closure. [28] In our previous papers, [10,27] we also reported our mature experience about using transthoracic echocardiography as the only guiding tool. With the help of the experienced sinologist, the different acoustic view by TTE can provide a satisfactory visualization to guide our operation, which may make the transthoracic procedure more simple.…”

Section: Discussionmentioning

confidence: 99%

“…In previous reports, we have introduced this domestic device. [10] The device consists of an occluder made from an alloy of nickel and titanium, a metal delivered sheath, and a pushing rod. The double disc occluder has a 10-cm thread in the right disc, facilitating its withdrawal into the 40-cm long and 3 to 6 diameter sheath.…”

Section: Methodsmentioning

confidence: 99%

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Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect

Chen

Cao²,

Chen³

et al. 2017

Medicine

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The purpose of this study was to compare patient populations, safety, feasibility, complications, and total costs of the transcatheter and transthoracic device closure treatments for secundum atrial septal defect.From January 2014 to December 2014, we enrolled 155 patients with secundum atrial septal defects in our hospital. The patients were divided into 2 groups: the 70 patients in group A underwent transcatheter device closure, and the 85 patients in group B underwent transthoracic intraoperative device closure with a right lateral mini-thoracotomy.In group A, the total occlusion rate was 94.3% immediately after the operation, 100% at 3 months, and 100% at 12 months of follow-up; the group A results were not statistically different from the group B results (94.1%, 98.8%, 98.8%, respectively). There was a statistically significant difference in the minor complication rate (P < 0.05), and there were no reported deaths. There was a greater indicated scope using the transthoracic closure device to treat atrial septal defects. In our comparative study, the patients in group B had longer intensive care unit stays and hospital stays than group A (P < 0.05).Both of the device closure treatment options for secundum atrial septal defect are safe and feasible. The transcatheter device closure approach has the advantages of more cosmetic results, less trauma, and a shorter hospital stay than the transthoracic approach. On the contrary, the transthoracic closure device is an economical alternative choice, particularly for patients who are not eligible for the transcatheter closure device.

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“…Reports of devices similar to ASO from China but larger than 40 mm showed feasibility of closure of ASD using devices up to 46 mm . These devices were initially deployed by hybrid surgical per‐atrial techniques . Data are scarce on the safety of these devices, especially its impact on erosions, arrhythmias, valvar regurgitation, thrombus formation, and embolization.…”

Section: Introductionmentioning

confidence: 99%

Feasibility, safety and midterm follow‐up of patients after nonsurgical closure of atrial septal defects using very large 40–46 mm nitinol septal occluders

Sivakumar

Viswambaran

Bhattacharjya

2018

Cathet Cardio Intervent

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Objectives To study the feasibility of closure of large atrial septal defects (ASDs) using occluder devices >38 mm and assess the midterm complications. Background Feasibility and safety of large occluders >38 mm and their follow‐up are largely unknown. Methods All patients with ASDs closed using devices >38 mm were retrospectively analyzed. Since outcome of patients receiving 40 mm devices were known before, patients receiving 40 mm devices were compared with those receiving 42–46 mm devices on demographic, hemodynamic parameters and procedural characteristics. Results A total of 17 patients with 40‐mm device and 31 patients with >40‐mm device formed the cohort. The mean echocardiographic defect size was 36.3 ± 3.7 mm. In total 19 patients had deficient retroaortic margin; inferior margin was deficient in one. Larger defects needed special deployment techniques more often. There was acute technical success in all patients. Two procedures failed; one device embolization next day in a patient with deficient inferior margin needed surgery. Another elderly patient with restrictive left ventricular physiology died of multiorgan dysfunction. Two late deaths on follow‐up were unrelated to the procedure. All other patients had symptom improvement. There were no erosions, thromboembolism or valvar regurgitation at a median follow‐up of 39 (1–60) months. Apart from late‐onset atrial flutter in one, there were no arrhythmias on follow‐up. Conclusions Occluders larger than 38 mm in appropriately selected patients are feasible, successful and safe in majority and often require special deployment techniques. Complications during and after the procedure were infrequent. Very large defects with any deficient margin except retroaortic rim should be excluded from device closure.

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Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion

Abstract: Intra-operative device closure of atrial septal defect with transthoracic minimal invasion is a safe and feasible technique. It had the advantages of cost savings, yielding better cosmetic results, and leaving less trauma than surgical closure.

Cited by 19 publications

References 23 publications

Percutaneous occluder device closure through femoral vein guidance by transthoracic echocardiography in adult atrial septal defect patients

Percutaneous occluder device closure through femoral vein guidance by transthoracic echocardiography in adult atrial septal defect patients

Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect

Feasibility, safety and midterm follow‐up of patients after nonsurgical closure of atrial septal defects using very large 40–46 mm nitinol septal occluders

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