title: Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience.
abstract: OBJECTIVE
  To determine event-free survival after transcatheter closure of ventricular septal defect (VSD), and to identify predictors of adverse events (AE) in post myocardial infarction VSD (post-MI VSD) subgroup.
  
  
  BACKGROUND
  There are limited data on mid-term follow-up after transcatheter VSD closure.
  
  
  METHODS
  Retrospective review of 27 cases of transcatheter VSD closure (post-MI = 18 and non-ischemic = 9) performed from 1999 to 2013. We defined AE as death, device embolization, hemolysis requiring blood transfusion, heart block and reintervention.
  
  
  RESULTS
  In the post-MI VSD subgroup, mean age and follow-up was 69 ± 11 and 7.3 ± 7 years, respectively. AE occurred in 8 (44%) patients (death-3, device embolization-1, hemolysis-1, surgical VSD closure-2, reintervention-1). Event-free survival was 56% at 1 month and 5 years, and all AE occurred in the periprocedural period. Cardiogenic shock (HR: 3.21, CI: 1.82-5.41, P = 0.002), and VSD closure in acute phase (HR: 2.14, CI: 1.12-4.31, P = 0.004) were independent predictors of AE. In the non-ischemic VSD subgroup, mean age and follow-up was 49 ± 15 and 8.7 ± 8 years, respectively. AE occurred in 3 (33%) patients (late death-1, surgical VSD closure-2). For the entire cohort, freedom from death was 89% and 85% at 1 month and 5 years, and event-free survival was 70% and 61% at 1 month and 5 years.
  
  
  CONCLUSIONS
  Transcatheter closure of post-MI VSD carries a moderate risk of periprocedural complications but low event rates afterwards. By comparison, device closure of non-ischemic VSD has lower periprocedural morbidity but some patients continued to experience AE during follow-up.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic Rochester, Minnesota.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Egbe
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Poterucha
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic Rochester, Minnesota.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota.
authors.forename: Nathaniel W
authors.initials: NW
authors.lastname: Taggart
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota.
authors.forename: Frank
authors.initials: F
authors.lastname: Cetta
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota.
authors.forename: Allison K
authors.initials: AK
authors.lastname: Cabalka
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Pollak
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic Rochester, Minnesota.
authors.forename: Guy S
authors.initials: GS
authors.lastname: Reeder
authors.affiliation: Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Hagler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D007049:Iatrogenic Disease; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy
keywords: myocardial infarction; transcatheter; ventricular septal defect