Contributors to and impact of residual shunting after device closure of atrial septal defects.
The prevalence of residual shunt in patients after device closure of atrial septal defect and its impact on long-term outcome has not been previously defined.



From a prospective, single-institution registry of 408 patients, we selected individuals with agitated saline studies performed 1 year after closure. Baseline echocardiographic, invasive hemodynamic, and comorbidity data were compared to identify contributors to residual shunt. Survival was determined by review of the medical records and the Social Security Death Index. Survival analysis according to shunt included construction of Kaplan-Meier curves and Cox proportional hazards modeling.



Among 213 analyzed patients, 27% were men and age at repair was 47 ± 17 years. Thirty patients (14%) had residual shunt at 1 year. Residual shunt was more common with Helex (22%) and CardioSEAL/STARFlex (40%) occluder devices than Amplatzer devices (9%; P = .005). Residual shunts were more common in whites (79% vs 46%, P = .004). At 7.3 ± 3.3 years of follow-up, 13 (6%) of patients had died, including 8 (5%) with Amplatzer, 5 (25%) with CardioSEAL/STARFlex, and 0 with Helex devices. Patients with residual shunting had a higher hazard of death (20% vs 4%, P = .001; hazard ratio 4.95 [1.59-14.90]). In an exploratory multivariable analysis, residual shunting, age, hypertension, coronary artery disease, and diastolic dysfunction were associated with death.



Residual shunt after atrial septal defect device closure is common and adversely impacts long-term survival.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
Michael J
MJ
Zdradzinski
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
Rachel L
RL
Elkin
Cardiovascular Medicine, Cleveland Clinic's Heart and Vascular Institute, Cleveland, OH.
Joanne M
JM
Lee
Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.
Athar M
AM
Qureshi
Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, TX.
Wael
W
El-Mallah
Cardiology Division, Duke University Health System/Duke University School of Medicine, Durham, NC. Electronic address: richard.krasuski@duke.edu.
Richard A
RA
Krasuski
D000328:Adult; D004452:Echocardiography; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D055989:Septal Occluder Device / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome