Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects: The Mayo Clinic experience

Alexander Egbe, Joseph T. Poterucha, Charanjit S. Rihal, Nathaniel W. Taggart, Frank Cetta, Allison K. Cabalka, Peter M. Pollak, Guy S. Reeder, Donald J. Hagler

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Objectives 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.

Original languageEnglish (US)
Pages (from-to)1264-1270
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume86
Issue number7
DOIs
StatePublished - Dec 1 2015

Fingerprint

Ventricular Heart Septal Defects
Infarction
Disease-Free Survival
Myocardial Infarction
Hemolysis
Equipment and Supplies
Heart Block
Cardiogenic Shock
Blood Transfusion
Morbidity

Keywords

  • myocardial infarction
  • transcatheter
  • ventricular septal defect

ASJC Scopus subject areas

  • Medicine(all)
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects : The Mayo Clinic experience. / Egbe, Alexander; Poterucha, Joseph T.; Rihal, Charanjit S.; Taggart, Nathaniel W.; Cetta, Frank; Cabalka, Allison K.; Pollak, Peter M.; Reeder, Guy S.; Hagler, Donald J.

In: Catheterization and Cardiovascular Interventions, Vol. 86, No. 7, 01.12.2015, p. 1264-1270.

Research output: Contribution to journalReview article

Egbe, Alexander ; Poterucha, Joseph T. ; Rihal, Charanjit S. ; Taggart, Nathaniel W. ; Cetta, Frank ; Cabalka, Allison K. ; Pollak, Peter M. ; Reeder, Guy S. ; Hagler, Donald J. / Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects : The Mayo Clinic experience. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 86, No. 7. pp. 1264-1270.
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abstract = "Objectives 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.",
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T1 - Transcatheter closure of postmyocardial infarction, iatrogenic, and postoperative ventricular septal defects

T2 - The Mayo Clinic experience

AU - Egbe, Alexander

AU - Poterucha, Joseph T.

AU - Rihal, Charanjit S.

AU - Taggart, Nathaniel W.

AU - Cetta, Frank

AU - Cabalka, Allison K.

AU - Pollak, Peter M.

AU - Reeder, Guy S.

AU - Hagler, Donald J.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objectives 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.

AB - Objectives 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.

KW - myocardial infarction

KW - transcatheter

KW - ventricular septal defect

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