Page 79 - Journal of Structural Heart Disease Volume 2, Issue 6

Meeting Abstracts
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this speci c subgroup when compared to small and moderate size defects. We sought to determine clinical and anatomical predictors of procedural failure in patients undegoing percutaneous closure of atrial septal defects larger than 24mm using the AmplatzerTM Occluder device (St.Jude Medical Inc.).
Method & Results: Adult patients refered between January 2006 and July 2013 for percutaneous closure of a secundum atrial sep- tal defect (ASD) with a stretched diameter higher than 24 mm were included in this study. Clinical, imaging and procedural data were retrospectively collected from index admission to last follow-up. Patients underwent ASD closure according to standard indications under transeosophageal and uoroscopic guidance. A total of 90 patients, mean age 47±16 years, 60% female, met inclusion crite- ria. Patients presented with right heart failure symptoms in 81,1 % of cases, 93,3 % had right ventricular enlargement and 7,8 % had a prior embolic event. Median non-stretched and stretched ASD diameters were 24,0 mm (20;28) and 29,0 mm (25,5;34,0) respec- tively. Procedural success rate was 81,1 %, one patient (2,2%) rec- quired emergent surgery because of a ruptured septum after sizing-balloon in ation resulting in cardiac tamponnade. During a median follow-up of 19,5 months, we observed 4 (4,4%) episodes of systemic thrombo-embolism, 5 (5,5%) new onset supraventricular tachyarrhytmias, no cardiac erosion, no device embolization and no cardiovascular death.
In univariate logistic regression analysis predictors of failure were non-stretched diameter (OR= 1,25 per mm; p=0,0002), stretched
diameter (OR=1,6 per mm; p<0,0001), absence of any type of mar- gin (OR= 4,8, p<0,0001) and absence of postero-inferior margin (OR= 39,3; p<0,0001). Multivariate regression analysis identi ed non- stretched diameter (OR= 1,17 per mm; p=0,05), absence of any type of margin (OR=5,25; p=0,0004) and absence of postero-inferior mar- gin (OR>100, p=0,05) as independent predictors of failure.
Conclusion: Success rate of transcatheter closure of large atrial sep- tal defects using the amplatzer device is lower when compared to small to moderate defects. A large unstretched diameter, absence of any type of margin and more strongly absence of postero-inferior margin were independantly associated with procedural failure. These ndings can be assessed prior to the procedure and could improve patient selection.
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Journal of Structural Heart Disease, December 2016
Volume 2, Issue 6:241-306
Cite this article as: Hijazi ZM. The Pediatric and Adult Interventional Cardiac Symposium (PICS/AICS) – 20th Annual Meeting. Structural Heart Disease 2016;2(6):241-306. DOI: http://dx.doi.org/10.12945/j.jshd.2016.16.013