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. 2022 Dec 22;10(1):1.
doi: 10.3390/jcdd10010001.

Impact of Persistent Iatrogenic Atrial Septal Defect following MitraClip

Chieh-Ju Chao  1 , Amith Seri  2 , Bishoy Abraham  2 , Juan M Farina  2 , Evelyn Fennelly  2 , Megan Campany  2 , Milagros Pereyra  2 , Ebram F Said  2 , Courtney Kenyon  2 , Ayman R Fath  1 , Sean Smith  2 , Skye Buckner-Petty  2 , Corbin A Rayfield  2 , David Fortuin  2 , John P Sweeney  2 , Eric H Yang  2 , Chadi Ayoub  2 , Mackram F Eleid  1 , Mohamad Alkhouli  1 , Charanjit S Rihal  1 , David R Holmes  1 , Peter M Pollak  3 , Abdallah El Sabbagh  3 , Jae K Oh  1 , Reza Arsanjani  2
Affiliations

Impact of Persistent Iatrogenic Atrial Septal Defect following MitraClip

Chieh-Ju Chao et al. J Cardiovasc Dev Dis. .

Abstract

Background: Prior studies have reported conflicting results of persistent iatrogenic atrial septal defect (iASD) and its impact following a transcatheter edge-to-edge repair (TEER) procedure. This study aims to evaluate the incidence of iASD and its clinical and hemodynamic impact after a TEER.

Methods: Consecutive patients who underwent a TEER procedure from June 2014 to September 2020 at the Mayo Clinic were identified. The presence of iASD was retrospectively identified on post-procedure transthoracic echocardiography (TTE) to group patients into an iASD+ group and an iASD- group for comparison of prognosis and cardiac function.

Results: A total of 316 patients were included; the mean age was 79.1 ± 9.1 years, and 67.7% were male. Persistent iASD was diagnosed in 108 (34.2%) patients. There was no difference concerning all-cause mortality, heart failure hospitalization, and stroke/TIA between groups at follow-up (median follow-up of 9 months). Post-procedure TTE demonstrated no differences regarding right ventricle (RV) and left ventricle (LV) dimensions and function, including TAPSE (15.2 ± 4.6 vs. 15.4 ± 5.5 mm, p = 0.875), and LV ejection fraction (51.1 ± 14.0% vs. 51.3 ± 13.9%, p = 0.933). However, patients with iASD had higher RV systolic pressure (48.7 ± 14.4 vs. 45.5 ± 14.5 mmHg, p = 0.042) compared with patients without iASD.

Conclusion: Notwithstanding higher RV pressures, patients with persistent iASD had no hemodynamic compromise and an equal prognosis compared with those without a residual atrial defect after a TEER procedure. These findings support the mid-term safety of procedures in which an interatrial defect needs to be created and would argue against the need for interventional closure.

Keywords: echocardiography; endovascular procedures; mitral valve insufficiency.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Clinical outcomes comparison between groups (iASD+ vs. iASD−). No significant differences were seen in mortality (panel A), readmissions due to heart failure (panel B) and stroke/TIA (panel C).
Figure 2
Figure 2
Clinical outcomes comparison between groups (iASD+ vs. iASD−) for patients with right ventricle systolic dysfunction. No significant differences were seen in mortality (panel A), readmissions due to heart failure (panel B) and stroke/TIA (panel C).
Figure 3
Figure 3
Clinical outcomes comparison for patients with a persistent interatrial septal defect according to the flow direction (left to right vs. right to left or bilateral). No significant differences were seen in mortality (panel A), readmissions due to heart failure (panel B) and stroke/TIA (panel C).
See this image and copyright information in PMC

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