Page 9 - Journal of Structural Heart Disease Volume 3, Issue 4

Original Research Article
Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:96-101
DOI: https://doi.org/10.12945/j.jshd.2017.001.17
Percutaneous Atrial Septal Closure in Immunocompromised Patients
Received: January 08, 2017 Accepted: January 27, 2017 Published online: August 2017
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 Ge en School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
2 Division of Cardiology, David Ge en 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
condition suggests that percutaneous closure of a PFO or ASD is safe in immunocompromised patients. Copyright © 2017 Science International Corp.
Key Words
Percutaneous closure • Immunocompromised • Atrial septal defect • Patent foramen ovale • Stroke • Migraine
Introduction
Intra-cardiac defects such as patent foramen ovale (PFO) and atrial septal defect (ASD) are often closed o -label for cryptogenic stroke, migraine, or hemodynamically signi cant ASD. The incidence of device-related infection in patients with normal im- mune systems who undergo closure is exceedingly rare. In a retrospective survey of PFO closure device explantation, only 38 devices were explanted for var- ious reasons out of 13,736 cases (0.28%), with only one explanted due to endocarditis [1]. Some risk fac- tors may predispose patients to greater risk of infec- tion of a closure device, such as diabetes, renal failure, organ transplant, immunosuppressed state, or auto- immune disease. The safety of PFO or ASD closure in patients who are immunocompromised or have an autoimmune disorder is unknown because patients with these conditions are excluded from randomized
* Corresponding Author:
Jonathan M. Tobis, MD, MSCAI
Interventional Cardiology Research
University of California at Los Angeles Medical Center,
757 Westwood Plaza, Los Angeles, California 90095, USA
Tel.: +1 310 794 4797, Fax: +1 310 267 0384; E-Mail: jtobis@mednet.ucla.edu
Background: Percutaneous closure devices for cardiac defects have been used with a high degree of e cacy and safety. However, patients with autoimmune dis- ease 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 immunosup- pressed 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 Immunode ciency Virus, hep- atitis, cancer, or renal transplant and underwent per- cutaneous PFO or ASD closure for cryptogenic stroke (9.38%), desaturation (5.21%), migraine (7.29%), or a combination of these diagnoses (3.13%). Post-pro- cedure 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 endo- carditis, device erosion, exacerbation of migraine, or recurrent stroke. Only one patient (4%) experienced a transient neurologic de cit after closure due to com- plex migraine with visual aura. Mortality status, which was veri ed by the social security death index, showed ve deaths related to non-cardiac conditions. Conclusion: This observational study of an uncommon
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