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Canadian Journal of Cardiology

Long-term Complications After Transcatheter Atrial Septal Defect Closure: A Review of the Medical Literature

  • Zakaria Jalal
    Correspondence
    Corresponding author: Dr Zakaria Jalal, University Hospital of Bordeaux, 33000 Bordeaux, France. Tel.: 00-33-5-57-65-64-65; fax: 00-33-5-57-65-68-28.
    Affiliations
    Groupe de cathétérisme interventionnel pédiatrique et congénital, Filiale de cardiologie pédiatrique et congénitale de la Société Française de Cardiologie, Paris, France

    University Hospital of Bordeaux—Department of Paediatric and Adult Congenital Heart Defects, Bordeaux, France

    Université Victor Segalen, Bordeaux, France
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  • Sebastien Hascoet
    Affiliations
    Groupe de cathétérisme interventionnel pédiatrique et congénital, Filiale de cardiologie pédiatrique et congénitale de la Société Française de Cardiologie, Paris, France

    Paediatric and Congenital Cardiac Surgery, M3C Marie-Lannelongue Hospital, Paris Sud University, Paris, France
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  • Alban-Elouen Baruteau
    Affiliations
    Groupe de cathétérisme interventionnel pédiatrique et congénital, Filiale de cardiologie pédiatrique et congénitale de la Société Française de Cardiologie, Paris, France

    Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital at New York Presbyterian, Columbia University, New York, New York, USA
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  • Xavier Iriart
    Affiliations
    University Hospital of Bordeaux—Department of Paediatric and Adult Congenital Heart Defects, Bordeaux, France
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  • Bernard Kreitmann
    Affiliations
    University Hospital of Bordeaux—Department of Paediatric and Adult Congenital Heart Defects, Bordeaux, France
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  • Younes Boudjemline
    Affiliations
    Groupe de cathétérisme interventionnel pédiatrique et congénital, Filiale de cardiologie pédiatrique et congénitale de la Société Française de Cardiologie, Paris, France

    Centre de Référence Malformations Cardiaques Congénitales Complexes—M3C, Pediatric Cardiology, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paris, France

    Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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  • Jean-Benoit Thambo
    Affiliations
    Groupe de cathétérisme interventionnel pédiatrique et congénital, Filiale de cardiologie pédiatrique et congénitale de la Société Française de Cardiologie, Paris, France

    University Hospital of Bordeaux—Department of Paediatric and Adult Congenital Heart Defects, Bordeaux, France

    Université Victor Segalen, Bordeaux, France
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Published:March 02, 2016DOI:https://doi.org/10.1016/j.cjca.2016.02.068

      Abstract

      Percutaneous closure has evolved to become the first-line treatment strategy for most cases of secundum atrial septal defect (ASD) in both adults and children. Its safety and efficacy have been proved; percutaneous ASD occlusion offers many advantages over surgical closure, including avoidance of cardiopulmonary bypass, avoidance of sternotomy scar, shorter hospitalization, and a potentially lower incidence of postprocedural complications. Periprocedural course and short-term outcome have been widely described, with low mortality and morbidity rates. However, the wide use of ASD closure devices and the growing experience worldwide brought some delayed and rare complications to light. Device thrombosis and cardiac erosion are the most severe late complications of device closure, whereas atrial arrhythmias are the most common. Other delayed complications include nickel allergy, cardiac conduction abnormalities, valvular damage, and device endocarditis. The long-term complication rate is not null and, although rare, some of these complications may be sudden and potentially life-threatening. Moreover, the occurrence and rate of these complications vary with the different devices used currently or in the past. Therefore, both operators and patients need to be aware of these issues to assist them in the choice of intervention or device, or both, and to adapt follow-up modalities. In this review, we sought to describe the type, incidence, and outcome of these rare but potentially serious device closure delayed complications.

      Résumé

      La fermeture par voie percutanée est devenue la stratégie de traitement de première intention de la plupart des cas de communications interauriculaires (CIA) de type ostium secundum chez les adultes et les enfants. Son innocuité et son efficacité ont été démontrées; l’occlusion par voie percutanée de la CIA offre plusieurs avantages par rapport à la fermeture par voie chirurgicale, y compris l’évitement du pontage cardiopulmonaire, l’évitement de la cicatrice de sternotomie, l’hospitalisation plus courte et une fréquence potentiellement plus faible des complications postopératoires. L’évolution périopératoire et les résultats à court terme ont largement démontré de faibles taux de mortalité et de morbidité. Cependant, la vaste utilisation des dispositifs de fermeture de la CIA et l’expérience accumulée dans le monde entier ont mis en lumière quelques complications tardives et rares. La thrombose sur dispositif et l’érosion cardiaque sont les complications tardives les plus graves de la fermeture par dispositif, alors que les arythmies auriculaires sont les plus fréquentes. Parmi les autres complications tardives, on note l’allergie au nickel, les troubles de conduction cardiaque, les lésions valvulaires et les endocardites liées à un dispositif. Le taux de complications à long terme n’est pas nul. Toutefois, bien que les complications soient rares, certaines sont subites et peuvent potentiellement mettre la vie en danger. De plus, la survenue et la fréquence de ces complications varient selon les dispositifs utilisés actuellement ou par le passé. Par conséquent, les opérateurs et les patients doivent être conscients de ces problèmes pour faire un choix d’intervention ou de dispositif, ou les deux, et adapter les modalités du suivi. Dans cette revue, nous avons cherché à décrire le type, la fréquence et les résultats concernant ces complications tardives liées à la fermeture par dispositif, qui s’avèrent rares, mais potentiellement sérieuses.
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