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

4 Citations (Scopus)

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

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Atrial Heart Septal Defects
Meta-Analysis
Confidence Intervals
Safety
Endocarditis
Atrial Fibrillation
Cardiac Arrhythmias
Thrombosis
Stroke
Databases
Equipment and Supplies

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Long term outcomes among adults post transcatheter atrial septal defect closure : Systematic review and meta-analysis. / Alnasser, Sami; Lee, Douglas; Austin, Peter C.; Labos, Christopher; Osten, Mark; Lightfoot, David T.; Kutty, Shelby; Shah, Ashish; Meier, Lukas; Benson, Lee; Horlick, Eric.

In: International Journal of Cardiology, Vol. 270, 01.11.2018, p. 126-132.

Research output: Contribution to journalArticle

Alnasser, S, Lee, D, Austin, PC, Labos, C, Osten, M, Lightfoot, DT, 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, vol. 270, pp. 126-132. https://doi.org/10.1016/j.ijcard.2018.06.076
Alnasser, Sami ; Lee, Douglas ; Austin, Peter C. ; Labos, Christopher ; Osten, Mark ; Lightfoot, David T. ; Kutty, Shelby ; Shah, Ashish ; Meier, Lukas ; Benson, Lee ; Horlick, Eric. / Long term outcomes among adults post transcatheter atrial septal defect closure : Systematic review and meta-analysis. In: International Journal of Cardiology. 2018 ; Vol. 270. pp. 126-132.
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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.",
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AU - Austin, Peter C.

AU - Labos, Christopher

AU - Osten, Mark

AU - Lightfoot, David T.

AU - Kutty, Shelby

AU - Shah, Ashish

AU - Meier, Lukas

AU - Benson, Lee

AU - Horlick, Eric

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N2 - 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.

AB - 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.

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