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Contributors to and impact of residual shunting after device closure of atrial septal defects.

Publication ,  Journal Article
Zdradzinski, MJ; Elkin, RL; Lee, JM; Qureshi, AM; El-Mallah, W; Krasuski, RA
Published in: Am Heart J
July 2016

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Residual shunt after atrial septal defect device closure is common and adversely impacts long-term survival.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2016

Volume

177

Start / End Page

112 / 119

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Septal Occluder Device
  • Registries
  • Prospective Studies
  • Proportional Hazards Models
  • Prognosis
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Zdradzinski, M. J., Elkin, R. L., Lee, J. M., Qureshi, A. M., El-Mallah, W., & Krasuski, R. A. (2016). Contributors to and impact of residual shunting after device closure of atrial septal defects. Am Heart J, 177, 112–119. https://doi.org/10.1016/j.ahj.2016.03.022
Zdradzinski, Michael J., Rachel L. Elkin, Joanne M. Lee, Athar M. Qureshi, Wael El-Mallah, and Richard A. Krasuski. “Contributors to and impact of residual shunting after device closure of atrial septal defects.Am Heart J 177 (July 2016): 112–19. https://doi.org/10.1016/j.ahj.2016.03.022.
Zdradzinski MJ, Elkin RL, Lee JM, Qureshi AM, El-Mallah W, Krasuski RA. Contributors to and impact of residual shunting after device closure of atrial septal defects. Am Heart J. 2016 Jul;177:112–9.
Zdradzinski, Michael J., et al. “Contributors to and impact of residual shunting after device closure of atrial septal defects.Am Heart J, vol. 177, July 2016, pp. 112–19. Pubmed, doi:10.1016/j.ahj.2016.03.022.
Zdradzinski MJ, Elkin RL, Lee JM, Qureshi AM, El-Mallah W, Krasuski RA. Contributors to and impact of residual shunting after device closure of atrial septal defects. Am Heart J. 2016 Jul;177:112–119.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2016

Volume

177

Start / End Page

112 / 119

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Septal Occluder Device
  • Registries
  • Prospective Studies
  • Proportional Hazards Models
  • Prognosis
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate