Transcatheter closure of atrial septal defect in a geriatric population

Nakagawa, Koji; Akagi, Teiji; Taniguchi, Masaru; Kijima, Yasufumi; Goto, Keiji; Kusano, Kengo; Itoh, Hiroshi; Sano, Shunji

doi:10.1002/ccd.23457

Cited by 42 publications

(50 citation statements)

References 30 publications

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“…42 Tricuspid valve repair is recommended for patients with significant TR, undergoing surgical ASD closure, 2 wherein persistent tricuspid insufficiency, more than moderate, after ASD closure has been suggested to be related to poor prognosis. 43, 44 However, in accordance with the study by Nakagawa et al, 45 in the present study, for those patients who had moderate or severe TR before percutaneous closure, TR severity was improved for most (87%; 21 of 23) of the patients. The incidence of persistent TR in our study was lower than that reported by Toyono et al in 2009.…”

Section: Changes In Tr Severitysupporting

confidence: 80%

“…42 Our finding may lend support to the view that TR severity does not necessarily become an exclusion criterion for the choice of percutaneous closure. 45 Preferably, we currently base our decision on multiple aspects, such as age and tricuspid valve anatomy, upon deciding whether concomitant tricuspid valve repair surgery is required.…”

Section: Changes In Tr Severitymentioning

confidence: 99%

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Comparison of Clinical Outcomes After Transcatheter vs. Minimally Invasive Cardiac Surgery Closure for Atrial Septal Defect

Kodaira

Kawamura

Okamoto

et al. 2017

Circ J

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nickel allergy. 6, 7 Technological advances have made contemporary surgery less invasive than classical surgery using full sternotomy. Cardiac surgery performed without full sternotomy is called minimally invasive cardiac surgery (MICS). 8 Advantages of MICS are swift recovery and reduction of pain and sternal wound infection. Furthermore, it is cosmetically appealing, considering the higher prevalence of women and the relatively young population of patients with ASD compared with the typical surgical population. 9 MICS for ASD has been shown to be a safe procedure with satisfactory long-term outcomes. 10,11 More recently, MICS has used endoscopy through a small skin incision in the right chest wall, and is called a right mini-thoracotomy MICS. 12 The aim of this study was to compare percutaneous closure with right mini-thoracotomy MICS for secundum ASD because to date, no direct comparison has been made in terms of efficacy and safety. We also report data on the S ecundum atrial septal defect (ASD) is one of the most common congenital cardiac malformations. 1 Guidelines recommend closure of ASD in patients with right ventricular enlargement, regardless of symptoms. 2 Surgical closure was performed for the first time in 1953 and has been the gold standard for decades. Percutaneous ASD closure, on the other hand, was introduced in 1975. 3 In 2002, a non-randomized multicenter study compared percutaneous closure with surgery, and demonstrated comparable success rates. Notably, minor complication rates were significantly higher with surgery than with percutaneous closure, and the hospital stay was shorter with percutaneous closure. 4 Percutaneous closure has been widely performed and has replaced surgery, except in cases of large defects, insufficient rims, or a left atrium too small to accommodate a device. 2,5 However, concern remains regarding the requirement for prosthetic device implantation, which could eventually lead to delayed complications such as cardiac erosion, device thromboembolic events and Conclusions: Percutaneous closure and MICS had high success rates without deaths. For ASD patients with a suitable anatomy, percutaneous closure can be considered as the first therapeutic option.

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Section: Changes In Tr Severitysupporting

confidence: 80%

Section: Changes In Tr Severitymentioning

confidence: 99%

Comparison of Clinical Outcomes After Transcatheter vs. Minimally Invasive Cardiac Surgery Closure for Atrial Septal Defect

Kodaira

Kawamura

Okamoto

et al. 2017

Circ J

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“…Clinical features of ASD are widely varied from pediatric population through adults [3][4][5][6]. The majority of these children are asymptomatic and diagnosed by school physical examination, heart murmur detected by primary care pediatrician, and cardiac echocardiographic screening in the newborn period.…”

Section: Clinical Feature Of Asd In Various Aged Populationsmentioning

confidence: 99%

Current concept of transcatheter closure of atrial septal defect in adults

Akagi

2015

Journal of Cardiology

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After the introduction of catheter intervention for atrial septal defect (ASD) in the pediatric population, therapeutic advantages of this less invasive procedure were focused on adult through geriatric populations. The most valuable clinical benefits of this procedure are the significant improvement of symptoms and daily activities, which result from the closure of left to right shunt without thoracotomy and cardiopulmonary bypass surgery. These benefits contribute to increase the number of adult patients of this condition who have hesitated over surgical closure. In terms of technical point of view for catheter closure of ASD, the difficulties still exist in some morphological features of defect, or hemodynamic features in the adult population. Morphological features of difficult ASD closure are (1) large (≥30 mm) ASD, (2) wide rim deficiency, and (3) multiple defects. Hemodynamic features of difficult ASD are (1) severe pulmonary hypertension, (2) ventricular dysfunction, and (3) restrictive left ventricular compliance (diastolic dysfunction) after ASD closure. To complete the catheter ASD closure under these difficult conditions, various procedural techniques have been introduced. These are new imaging modalities such as real-time three-dimensional imaging, new technical modifications, and new concepts for hemodynamic evaluation. Especially, real-time three-dimensional transesophageal echocardiography can provide the high quality imaging for anatomical evaluation including maximum defect size, surrounding rim morphology, and the relationship between device and septal rim. In adult patients, optimal management for their comorbidities is an important issue, which includes cardiac function, atrial arrhythmias, respiratory function, and renal function. Management of atrial arrhythmias is a key issue for the long-term outcome in adult patients. Because the interventional procedures are not complication-free techniques, the establishment of a surgical back-up system is essential for the safe achievement of the procedure. Finally, the establishment of a team approach including pediatric and adult cardiologists, cardiac surgeons, and anesthesiologists is the most important factor for a good therapeutic outcome.

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“…(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) However, few studies were published considering geriatric patients, who older than 70 years. (18)(19)(20)(21) In this aged population, not only catheter closure of ASD but also surgical closure has been reported very limited experiences, little data are published on functional results. In this chapter, I would like to report our current experience of catheter closure of ASD in geriatric patients (70 years or more), and its long-term outcome.…”

Section: Introductionmentioning

confidence: 99%