Long term outcomes among adults post transcatheter atrial septal defect closure: Systematic review and meta-analysis

Sami Alnasser, Douglas Lee, Peter C. Austin, Christopher Labos, Mark Osten, David T. Lightfoot, Shelby Kutty, Ashish Shah, Lukas Meier, Lee Benson, Eric Horlick

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background: Transcatheter Closure (TC) has become the main stay therapy for many secundum atrial septal defects (ASD) based on short and intermediate term outcome data. Long-term safety and efficacy of this approach among adult patients however, is not well established. Methods and results: A comprehensive search of major electronic databases for studies reporting the long-term (≥5 year) outcomes post TC among adults yielded 114 studies, 9 of which had met the inclusion criteria. This included 1015 patients with a mean age of 45 years ± 5.5 years, two third were female with a mean follow up duration 6.4 years ± 2.7 years. The weighted proportions of long-term mortality and stroke with 95% confidence intervals (CI) were 2.4% (95%CI 0.9%–6.1%) and 2.1% (95%CI 0.7%–5.7%) respectively. Atrial arrhythmia occurred in 6.5% (95%CI 3.5%–11.7%) and atrial fibrillation in 4.9% (95%CI 1.9%–11.7%). ASD related re-interventions were encountered in 2.3% (95%CI 1.0%–5.4%) and residual shunt in 4.2% (95% CI 1.3%–12.4%), with 1 case of suspected device erosion 0.9% (95%CI 0.4–2.2%). Frame fractures and late migrations were observed at 4.2% (95%CI 1.5%–11.5%) and 1.2% (95%CI 0.3%–4%) respectively. No cases of occluder endocarditis or thrombosis were reported. In conclusion: This is the first study that systematically analyzes the long-term outcomes after TC providing important estimates for various clinical and occluder related outcomes. The analysis suggests preserved long-term safety post TC; however, this is limited due to the variable quality of available evidence and requires further assessment by larger studies with more comprehensive follow-up data.

Original languageEnglish (US)
Pages (from-to)126-132
Number of pages7
JournalInternational Journal of Cardiology
Volume270
DOIs
StatePublished - Nov 1 2018

Keywords

  • Atrial septal defects
  • Long-term outcomes
  • Meta-analysis
  • Transcatheter approach

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Alnasser, S., Lee, D., Austin, P. C., Labos, C., Osten, M., Lightfoot, D. T., Kutty, S., Shah, A., Meier, L., Benson, L., & Horlick, E. (2018). Long term outcomes among adults post transcatheter atrial septal defect closure: Systematic review and meta-analysis. International Journal of Cardiology, 270, 126-132. https://doi.org/10.1016/j.ijcard.2018.06.076