The influence of deficient retro-aortic rim on technical success and early adverse events following device closure of secundum atrial septal defects: An Analysis of the IMPACT Registry(®).

TitleThe influence of deficient retro-aortic rim on technical success and early adverse events following device closure of secundum atrial septal defects: An Analysis of the IMPACT Registry(®).
Publication TypeJournal Article
Year of Publication2017
AuthorsO'Byrne ML, Gillespie MJ, Kennedy KF, Dori Y, Rome JJ, Glatz AC
JournalCatheter Cardiovasc Interv
Volume89
Issue1
Pagination102-111
Date Published2017 Jan
ISSN1522-726X
KeywordsAdolescent, Cardiac Catheterization, Child, Child, Preschool, Female, Heart Septal Defects, Atrial, Humans, Infant, Infant, Newborn, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Prevalence, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Septal Occluder Device, Time Factors, Treatment Failure, United States, Young Adult
Abstract

BACKGROUND: Concern regarding aortic erosion has focused attention on the retro-aortic rim in patients undergoing device closure of atrial septal defects (ASD), but its effect on early outcomes is not well studied.

METHODS: A multicenter retrospective cohort study of patients undergoing device occlusion of ASD between 1/2011-10/2014 was performed, using data from the IMproving Pediatric and Adult Congenital Treatment Registry. Subjects were divided between those with retro-aortic rim <5 and ≥5 mm. Primary outcomes were technical failure and major early adverse events. Case times were measured as surrogates of technical complexity. The effect of deficient retro-aortic rim on primary outcomes was assessed using hierarchical logistic regression, adjusting for other suspected covariates and assessing whether they represent independent risk factors RESULTS: 1,564 subjects (from 77 centers) were included, with deficient retro-aortic rim present in 40%. Technical failure occurred in 91 subjects (5.8%) and a major early adverse event in 64 subjects (4.1%). Adjusting for known covariates, the presence of a deficient retro-aortic rim was not significantly associated with technical failure (OR: 1.3, 95% CI: 0.9-2.1) or major early adverse event (OR: 0.7, 95% CI: 0.4-1. 2). Total case (P = 0.01) and fluoroscopy time (P = 0.02) were greater in subjects with deficient rim, but sheath time was not significantly different (P = 0.07). Additional covariates independently associated with these outcomes were identified.

CONCLUSION: Deficient retro-aortic rim was highly prevalent but not associated with increased risk of technical failure or early adverse events. Studies with longer follow-up are necessary to assess other outcomes, including device erosion. © 2016 Wiley Periodicals, Inc.

DOI10.1002/ccd.26585
Alternate JournalCatheter Cardiovasc Interv
PubMed ID27189502
PubMed Central IDPMC5115996
Grant ListT32 HL007915 / HL / NHLBI NIH HHS / United States