Original Research Articles
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Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:96-101
DOI: 10.12945/j.jshd.2017.001.17
Percutaneous Atrial Septal Closure in Immunocompromised Patients
Subrata Kar, DO1, Jamil Aboulhosn, MD2, Anwar Tandar, MD3, Rubine Gevorgyan, MD1, Nicholas Miller, MS1, Jonathan M. Tobis, MD, MSCAI1*
1 Program of Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
2 Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
3 Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
Abstract
Background: Percutaneous closure devices for cardiac defects have been used with a high degree of efficacy and safety. However, patients with autoimmune disease or immunosuppression are excluded in clinical trials due to their presumed higher risk. Percutaneous closure of patent foramen ovale (PFO) or atrial septal defect (ASD) is safe in patients who are immunosuppressed or have autoimmune disease.
Methods: A retrospective observational multicenter study was performed including 24 patients who were immunocompromised or had autoimmune disease from vasculitis, Human Immunodeficiency Virus, hepatitis, cancer, or renal transplant and underwent percutaneous PFO or ASD closure for cryptogenic stroke (9.38%), desaturation (5.21%), migraine (7.29%), or a combination of these diagnoses (3.13%). Post-procedure follow-up included clinical evaluation at 3–6 months or telephone questionnaire up to 8 years later.
Results: Of the 24 patients who met inclusion criteria (53 ± 14 years of age, follow-up of 21 ± 28 months), 19 had a PFO (79%), 5 had an ASD (21%), and 21 (88%) underwent closure. There was no evidence of endocarditis, device erosion, exacerbation of migraine, or recurrent stroke. Only one patient (4%) experienced a transient neurologic deficit after closure due to complex migraine with visual aura. Mortality status, which was verified by the social security death index, showed five deaths related to non-cardiac conditions.
Conclusion: This observational study of an uncommon condition suggests that percutaneous closure of a PFO or ASD is safe in immunocompromised patients.
Cite this article as: Kar S, Aboulhosn J, Tandar A, Gevorgyan R, Miller N, Tobis JM. Percutaneous Atrial Septal Closure in Immunocompromised Patients. Structural Heart Disease 2017;3(4):96-101. DOI: 10.12945/j.jshd.2017.001.17
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Original Research Articles
Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:96-101
DOI: 10.12945/j.jshd.2017.001.17
Percutaneous Atrial Septal Closure in Immunocompromised Patients
Subrata Kar, DO1, Jamil Aboulhosn, MD2, Anwar Tandar, MD3, Rubine Gevorgyan, MD1, Nicholas Miller, MS1, Jonathan M. Tobis, MD, MSCAI1*
1 Program of Interventional Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
2 Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
3 Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
Abstract
Background: Percutaneous closure devices for cardiac defects have been used with a high degree of efficacy and safety. However, patients with autoimmune disease or immunosuppression are excluded in clinical trials due to their presumed higher risk. Percutaneous closure of patent foramen ovale (PFO) or atrial septal defect (ASD) is safe in patients who are immunosuppressed or have autoimmune disease.
Methods: A retrospective observational multicenter study was performed including 24 patients who were immunocompromised or had autoimmune disease from vasculitis, Human Immunodeficiency Virus, hepatitis, cancer, or renal transplant and underwent percutaneous PFO or ASD closure for cryptogenic stroke (9.38%), desaturation (5.21%), migraine (7.29%), or a combination of these diagnoses (3.13%). Post-procedure follow-up included clinical evaluation at 3–6 months or telephone questionnaire up to 8 years later.
Results: Of the 24 patients who met inclusion criteria (53 ± 14 years of age, follow-up of 21 ± 28 months), 19 had a PFO (79%), 5 had an ASD (21%), and 21 (88%) underwent closure. There was no evidence of endocarditis, device erosion, exacerbation of migraine, or recurrent stroke. Only one patient (4%) experienced a transient neurologic deficit after closure due to complex migraine with visual aura. Mortality status, which was verified by the social security death index, showed five deaths related to non-cardiac conditions.
Conclusion: This observational study of an uncommon condition suggests that percutaneous closure of a PFO or ASD is safe in immunocompromised patients.
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Cite this article as: Kar S, Aboulhosn J, Tandar A, Gevorgyan R, Miller N, Tobis JM. Percutaneous Atrial Septal Closure in Immunocompromised Patients. Structural Heart Disease 2017;3(4):96-101. DOI: 10.12945/j.jshd.2017.001.17
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