title: Percutaneous closure of atrial septal defect in adults: very long-term clinical outcome and effects on aortic and mitral valve function.
abstract: OBJECTIVE
  To investigate the very long-term clinical outcomes of atrial septal defect (ASD) percutaneous closure in adult patients and to evaluate the 12-month effects of the device on aortic and mitral valve function.
  
  
  METHODS
  Over a 12-year period, a total of 110 consecutive patients underwent percutaneous ASD closure. A yearly clinical follow-up was conducted and any adverse event was recorded. In a 55-patient echocardiographic subgroup, the baseline and 12-month aortic and mitral regurgitation rate was recorded.
  
  
  RESULTS
  Mean age was 50.9 ± 17 years and 75% of patients were female. Mean ASD echocardiographic dimension was 17.6 ± 6.2 mm (range, 5-36 mm). Procedural success rate was 97%. After a mean follow-up of 61.8 ± 34.9 months (range, 6-167 months), all-cause death occurred in 2 patients (1.8%) and the composite primary outcome of major adverse cardiovascular event (MACE) occurred in 5 patients (4.5%): 2 non-device related cardiac deaths occurred and 3 surgeries were required. The Kaplan-Meier analysis showed an event-free survival at 140 months of 90%. In the 12-month echocardiographic substudy, no case of significant (moderate or severe) new-onset aortic regurgitation was detected, while 1 case (1.8%) of worsening mild-to-moderate aortic regurgitation was described (P=.90). No case of significant new-onset or worsening mitral regurgitation was noted. No patient needed aortic or mitral surgical repair at very long-term follow-up.
  
  
  CONCLUSIONS
  Transcatheter ASD closure is a safe procedure with satisfactory very long-term clinical outcomes. The ASD device does not significantly affect aortic and mitral valve function.
authors.affiliation: Cardiovascular and Thoracic Department, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Turin, Italy. paolo.scacciatella@tin.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scacciatella
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
authors.forename: Alberto
authors.initials: A
authors.lastname: Pullara
authors.forename: Federico
authors.initials: F
authors.lastname: Conrotto
authors.forename: Matteo
authors.initials: M
authors.lastname: Marchetti
authors.forename: Gaetana
authors.initials: G
authors.lastname: Ferraro
authors.forename: Marco
authors.initials: M
authors.lastname: Pavani
authors.forename: Luigi
authors.initials: L
authors.lastname: Biasco
authors.forename: Dario
authors.initials: D
authors.lastname: Bongiovanni
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.forename: Fulvio
authors.initials: F
authors.lastname: Orzan
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004452:Echocardiography / Q000379:methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000009:adverse effects*