Transcatheter device closure of atrial septal defects in the elderly: technical considerations and short-term outcomes.
BACKGROUND
Device closure of an atrial septal defect (ASD) results in symptom-reduction, right heart remodelling and lower pulmonary artery pressures. However it is unclear if there is a chronological limit to these benefits and whether device closure is safe in elderly subjects. The aim of this study was, therefore, to assess the safety and efficacy of device closure in patients >60 years.


METHODS
Retrospective study of Amplatzer Septal Occluder device closures from a single institution (May 1999-August 2002).


RESULTS
Fifty subjects aged >60 years (range 60-85 years) had ASD device closure (27% of the total cohort). Defect size and shunt size were similar for both younger and older groups (2.2:1 in both groups, p=0.9) as were procedural duration, fluoroscopy time and device size deployed. Baseline right ventricular (RV) systolic pressure ((younger vs. older) 39 vs. 49 mmHg, p<0.001) and right ventricular size (45 vs. 51 mm, p<0.001) were greater in the older group. Following closure RV systolic pressure (49 vs. 45 mmHg, p<0.01) and RV size (51 vs. 44 mm, p=0.01) decreased in the older group.


CONCLUSIONS
Device closure of an ASD can be performed safely in older patients. The right heart shows signs of remodelling even in elderly subjects.
Swan
L
L
Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, Toronto General Hospital, University Health Network, Canada. lornaswan@yahoo.com
Varma
C
C
Yip
J
J
Warr
M
M
Webb
G
G
Benson
L
L
McLaughlin
P
P
D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects / Q000295:instrumentation; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D015897:Comorbidity; D020878:Device Removal; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D012107:Research Design; D012189:Retrospective Studies; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D017725:Ventricular Pressure; D020257:Ventricular Remodeling