Page 14 - Journal of Structural Heart Disease Volume 4, Issue 3

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Original Scienti c Article
Moreover, the presence of additional features were noted: aneurysmal tissue (a bulge > 10 mm in the atrial septum that moved back and forth), septal mal-alignment (deviation of the rims > 1.5 mm from each other), presence of prominent Eustachian valve and/or Chiari’s network, double septal contour (struc- ture parallel to atrial septum usually in the left atri- um), imsy septal portion (thin oppy, pliable septal tissue). The left atrial (LA) dimensions (coronal, lateral and anteroposterior lengths) were measured and the left atrial volume was calculated [14]. From an apical four-chamber view, the tricuspid and mitral valve an- nuli were measured. The right and left ventricle sizes were measured from the parasternal long axis view. The Z-values were calculated for all cardiac structures. The degree of inter-ventricular septum attening (0, 1, 2, 3) was documented, as an indicator of right ven- tricular volume overload [15, 16].
Hemodynamics, catheterization and device-related variables
The right ventricular and mean pulmonary artery pressure, the systemic-to-pulmonary shunt ratio (Qp:Qs), size, number and type of the device (Am- platzer vs. Occlutech) and durations of uoroscopy and the procedure were documented. The uoros- copy lms of all patients were reviewed o ine. The duration of device deployment was calculated from starting of the deployment of the left atrial disc out of the delivery sheath until the nal release of the device. If the deployment time exceeded 10 minutes, the procedure was considered prolonged.
Statistical and data analysis
The patients were divided into two groups accord- ing to the duration of deployment time: group I ≤ ten minutes; group II > ten minutes, de ned as prolonged procedure. Ten minutes was selected as a cut-o -time between short and prolonged procedure depending on the fact that time from deployment to release of the device was six to eight minutes in the majority of our cases. Therefore, we decided that ten minutes for device deployment (not the total procedure time) would be a rational cut-o limit to de ne short and prolonged procedure as the operator might consume additional two to four minutes due to di erent rea- sons which are not related to the procedure itself.
The groups were compared statistically to identify the demographic, echocardiographic (anatomical), and device-related or hemodynamic factors that pre- dict procedure prolongation. The data are expressed as the mean ± the standard deviation (SD). The dif- ferences between the means were calculated using Student's t-test. The di erences in categorical vari- ables were analyzed using Chi-square tests. Receiver Operating Characteristic (ROC) curves were designed to determine the cut-o values for the signi cant numeric variables that give the highest sensitivity and speci city. A stepwise binary logistic regression model was designed, taking procedure prolongation time or non-prolongation as dependent variable. All signi cant numerical and non-numerical parameters in univariate analysis were taken as independent vari- ables. In addition, the model was subjected to good- ness-of- t tests and a model without multicollinearity was preferred over one with multicollinearity.
Univariate and multivariate stepwise logistic re- gression was used to identify the most signi cant predictors of procedure prolongation. Moreover, the odds ratios were calculated. The level of statistical sig- ni cance was set at p ≤ 0.05. All statistical analyses were performed using IBM, SPSS Statistics version 22 (SPSS, Inc., Chicago, USA).
Results
Eighty-nine patients with ASD were referred for PTCC. After pre-procedure TEE, eight patients were not considered for PTCC of the defect due to large de- fect in relation to patient size (that the occluder de- vice which will be used will a ect the adjacent struc- tures) in three patients, de cient rims around the defect (< 5 mm, mainly the rim toward inferior vena cava) in three patients, and sinus venosus defect type in two patients.
Percutaneous transcatheter closure of the ASD was performed on 81 patients. Using the criteria de- scribed in the methods section, the procedure du- rations were short in 56 patients (group I) and pro- longed in 25 patients (group II). Tables 1 and 2 show the di erences between the two groups with respect to general demographics, variables related to the defect, cardiac chambers, and atrioventricular valves dimensions, degree of ventricular septum attening,
El-Segaier M. et al.
Predictors for Prolonged ASD Closure