Long-Term Outcomes After Percutaneous Closure of Ostium Secundum Atrial Septal Defect in€the€Young

ISS Fro Lir Ce an og triq Ca Ca Pé UM Tim Ch Fre OBJECTIVES This study sought to assess procedural characteristics, early clinical outcome, and long-term complications after transcatheter closure of atrial septal defect (ASD) in children. BACKGROUND Transcatheter closure has become the preferred strategy in most cases of isolated secundum ASD. However, reported experience in the pediatric population is limited. METHODS A 1998 to 2016 retrospective multicenter study was performed in 9 French tertiary institutions. All children who had an attempt of percutaneous ASD closure with an Amplatzer Septal Occluder were included. RESULTS In 1,326 children (39% males; median age, 9 years [0.7 to 18]; weight, 29 kg [3.6 to 92]), transcatheter ASD closure was performed. Median ASD size was 15 mm (3 to 41); 254 (19.1%) patients had a large ASD ($20 mm/m). Procedural success rate was 95.3% (95% confidence interval: 93.9% to 96.3%). No death was observed but periprocedural complications occurred in 24 patients (1.8%). After a median follow-up of 3.5 years (range 6 months to 18 years; 173 patients [13%] followed >10 years), delayed major complications were minimal (n 1⁄4 12; 1.04%) including no death and/or cardiac erosion. Periprocedural and delayed complications rates were significantly higher in children #15 kg (5.2% vs. 1.5%; p 1⁄4 0.007 and 3.1% vs. 0.7%; p < 0.007, respectively) and those with large ASD (3.5% vs. 1.4%; p 1⁄4 0.008 and 1.7% vs. 0.7%; p 1⁄4 0.052, respectively). CONCLUSIONS Transcatheter ASD closure using Amplatzer Septal Occluder is safe in children with a minimal rate of periprocedural complications and a favorable long-term outcome, especially with no death or cardiac erosion despite a substantial proportion of large defects. Children#15 kg and those with large ASDs had a greater risk of complications. (J Am Coll Cardiol Intv 2018;11:795–804) © 2018 by the American College of Cardiology Foundation. N 1936-8798/$36.00 https://doi.org/10.1016/j.jcin. 2018.01. 262 m the Bordeaux University Hospital (CHU), Department of Paediatric and Adult Congenital Cardiology, Pessac, France; IHU yc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; INSERM, ntre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France; M3C Marie-Lannelongue Hospital, Paediatric d Congenital Cardiac Surgery Department, Paris Sud University, Plessis-Robinson, France; Department of Paediatric Cardioly, Hopital des Enfants, Paul-Sabatier University, CHU de Toulouse, Toulouse, France; Cabinet de Cardiologie Foetale Pediaue et Congenitale Adulte, Strasbourg, France; CHRU de Lille, University Lille Nord-de-France, Faculté de Médecine, Hôpital rdiologique, Service des Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France; Service de Cardiologie et Maladies rdiovasculaires, Hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Unité de Cardiologie diatrique, Hôpital des Enfants Gatien de Clocheville, INSERM UMR 1069 et Université François Rabelais, Tours, France; Inserm R 1087—CNRS UMR6291, Institut du Thorax, Nantes University, Nantes, France; Paediatric and Congenital Cardiology, La one Hospital, M3C CHU de Marseille, Marseille, France; and the Department of Congenital Cardiology, Evelina London ildren’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom. This study was supported by the nchGovernment as part of the Investments of the Futureprogrammanagedby theNational ResearchAgency (ANR-10-IAHU-04). ABBR EV I A T I ON S