First Comprehensive Analysis of Outcomes in Adult Patients after Percutaneous Closure of Isolated Secundum Atrial Septal Defects.

BACKGROUND: Secundum atrial septal defect (ASD) is a common congenital heart defect in adults. If untreated, ASD leads to right ventricular (RV) failure, atrial arrhythmias, and pulmonary hypertension. The aim of this study is to analyze published data on outcomes and complications of percutaneous ASD closure in adults.

METHODS: PubMed searches performed for published literature on percutaneous ASD closure using the terms ASD, ASD closure or repair, and percutaneous or transcatheter closure.

RESULTS: A total of 23 studies, 1958 patients, were analyzed. Baseline characteristics showed mean age of 49.1 ± 1.7 years, Qp:Qs of 2.2 ± 0.05, defect size 19.4 ± 1 and device size 24.0 ± 0.7. The percentage of patients in NYHA class I, II and III was 42.4 ± 6.3, 40.0 ± 6.5, and 9.3 ± 3.0, respectively. Mean follow-up was 12.6 ± 4.9 months with a closure rate of 96.9% ± 1.4. Echocardiographic parameters of improvement included decrease in RV volume from 157.2 to 100.2 mL (p = 0.02), RV end-diastolic dimensions from 40.8 to 32.4 mm (p < 0.0001) and pulmonary artery systolic pressures from 42.2±2.2 to 34.4±2.4 (p < 0.0001). The percentage of patients in NYHA class II and III decreased from 55±7.5 to 15.9±4.4 (p = 0.0013). At the end of follow-up, complications included 1% mortality rate, 0.8% device embolization, 5.8% new onset arrhythmias and 1.2% need for surgical closure.

CONCLUSION: Our study confirms that percutaneous ASD closure in adults with moderate pulmonary hypertension and RV dilation is safe and effective with reverse remodeling and better functional capacity. Prospective studies are needed to evaluate efficacy of percutaneous ASD closure in adults with large defects, higher shunt ratios, and severe pulmonary hypertension.