UK multicenter experience using the gore septal occluder (GSO^TM) for atrial septal defect closure in children and adults

Abstract

The GSO(TM) implant can achieve comparable closure rates to the ASO(TM) in small to moderate atrial septal defects after 3 months. Longer fluoroscopy and procedure times are a drawback; however these should improve with familiarity with the implant and deployment system. The larger sheath size was not associated with increased complications in our cohort.

Transcatheter closure of atrial septal defects in children and adolescents: Single‐center experience with the GORE® septal occluder

“…Our mean fluoroscopy time was 9 min in the patients whose implantation was successful, much better than in former HSO studies , and comparable with the two published GSO studies in children . In any case, we experienced a learning curve like the others, meaning that we needed <5 min to conduct fluoroscopy in the last patients we treated, as long as they were straightforward.…”

“…The GSO is much easier to see than the HSO on both fluoroscopy and echocardiography. We wish to emphasize (and agree with the U.K. group) that flawless echo‐guidance is mandatory during GSO delivery, especially during deployment on the left atrial side, in fact it may be more important than fluoroscopy . As a consequence thereof, we could reduce fluoroscopy‐exposure during most interventions, and began implanting the GSO under TEE guidance alone—a routine procedure in many institutions nowadays .…”

“…In our experience, the patch‐like GSO can be used in children and adolescents to close atrial septal defects up to a maximum sized‐diameter of 18 mm—corresponding to a minimal GSO‐to‐ASD‐ratio of 1.66 in our series. Others have reported the same experience —comparable to the HSO limit . Therefore, this remains one of the major drawbacks of the GORE systems, as only small to medium ASDs can be closed successfully.…”

“…Nonetheless, implantation of an oversized GSO is anticipated to be relatively safe, even in deficient retro‐aortic rims. The soft PTFE‐covered frame can splay around the aorta without significant force towards the aortic root or the atrial roof .…”

“…The GORE® Septal Occluder (WL Gore & Associates, Flagstaff, AZ) is a new double‐disc device with a very flat profile and high compliance. It received CE Mark approval in June 2011, and has been implanted in many adults with patent foramen ovale (PFO), but rarely in children . We report about our initial experience with the GORE® Septal Occluder (GSO) for ASD closure in 45 children and adolescents with hemodynamically relevant ASDs due to left‐right shunt.…”