State-of-the-Art Atrial Septal Defect Closure Devices for Congenital Heart

Abstract

The purpose of this review is to describe the current state of the art in terms of available devices and indications for the transcatheter device closure of atrial septal defects (ASD) and patent foramen ovale (PFO) in children and young adults. Techniques for transcatheter device closure of ASD (TC-ASD) are well established and TC-ASD has a proven track record of efficacy and safety. Device erosion, a rare but potentially catastrophic adverse event of TC-ASD has raised questions about the relative safety of TC-ASD versus operative open heart surgical ASD closure (O-ASD). Despite a concerted effort to study the issue, there are no solutions that avoid the risk of erosions definitively when using the Amplatzer device. There is evidence that concern about erosions has changed practice in the United States, specifically that more patients are referred for O-ASD than in the past. Efforts to study these changes have also revealed more variation in TC-ASD practice than previously appreciated. New devices for ASD closure with properties that may reduce the risk of erosion are being developed and brought to market, but, in the meantime, cardiologists must continue to balance the risks and benefits of TC- and O-ASD closure. Recent studies demonstrating the superiority of PFO device closure over medical therapy for cryptogenic stroke is likely to lead to changes in practice for structural/interventional cardiologists. Previously, the overwhelming majority of ASD closure procedures were performed for right heart volume overload due to left to right shunt, but stroke prophylaxis may become a more significant part of the volume in pediatric/congenital catheterization laboratories. Care should be taken in extrapolating this data to children and younger adults, and important questions about patient selection remain unresolved.

GORE® Cardioform ASD Occluder experience in transcatheter closure of “complex” atrial septal defects

“…Thus, it could be defined as a self-centering device with an adjustable waist and considered an evolution of the self-centering device technology, since it brings together several advantages of both self-centering and not self-centering devices. [29][30][31]33,34 This device could be ideal in challenging clinical or anatomic settings, mainly in younger, small-size patients with large ASD and deficient rims or in the case of multifenestrated septum. In these scenarios, it could overcome the main concern of implanting a relatively bulky and stiff prosthesis inside a growing heart which could potentially interfere with cardiac electro-mechanical properties 35 and cause cardiac erosion.…”

Key Regulatory Differentially Expressed Genes in the Blood of Atrial Septal Defect Children Treated With Occlusion Devices

“…With the advancement of interventional therapy for congenital heart disease and the progress of device research and development, more and more patients with ASD receive interventional therapy, in which metal and degradable occluders are the two kinds of the most used closure devices in these days ( Morray, 2019 ; Shi et al, 2019 ; O’Byrne and Levi, 2019 ; Alnasser et al, 2018 ). One of the most important indicators for evaluating the histocompatibility of the occluder is the endothelialization induced by the occluders.…”

Patent foramen ovale in children: Unique pediatric challenges and lessons learned from adult literature

“…Even though PFO closure is more effective for secondary stroke prevention in relatively younger adult patients (under 45 years of age) as compared to older adults, this is still unproven in the pediatric population. [ 42 43 ] Similarly, PFO closure for secondary stroke prevention for clinically suspected TIA in children is not currently supported and needs further study.…”

“…Some of the less common reasons for surgical referral include child too small for device closure, documented allergy to nickel, and inability to tolerate antiplatelet therapy. [ 37 43 ] Surgical closure is accomplished by either primary suture or patch closure via either a traditional median sternotomy or a minimally invasive technique through a “mini-sternotomy” or video-assisted thoracoscopic surgery. [ 58 ] The second more common category includes the management of PFO in patients with underlying CHD.…”