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Catheter Cardiovasc Interv. 2017 Jan;89(1):102-111. doi: 10.1002/ccd.26585. Epub 2016 May 18.

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®.

Author information

1
Division of Cardiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences.
2
Department of Pediatrics, George Washington University School of Medicine and Health Sciences.
3
Division of Cardiology, The Children's Hospital of Philadelphia.
4
Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia.
5
Mid America Heart Institute St. Luke's Health System.
6
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania.

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.

KEYWORDS:

heart catheterization; outcomes research; pediatric cardiology

PMID:
27189502
PMCID:
PMC5115996
DOI:
10.1002/ccd.26585
[Indexed for MEDLINE]
Free PMC Article

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