Immediate Procedural Outcome
Success LAA occlusion, defined as having a residual flow of <
5mm around the device during the peri-procedural transesophageal
echocardiogram, was achieved in all patients. In patient 2, there was a
small residual of 2mm which was no longer seen in the follow-up
transesophageal echocardiogram at 3 months.
All patient had only single interatrial communication and had large ASDs
with significant left to right shunt. Three patients had pulmonary
vascular resistance index more than 4 Woods x m2.
However, given the significant left to right shunting, the ASDs were
closed. No patients required to have their ASD device fenestration
enlarged to offload the left ventricle due to a significant increase in
the left ventricular end-diastolic pressure, and expectedly, none had
acute pulmonary edema immediately after the ASD closure. All patients
were extubated successfully on table. All but two patients were
discharged 1 day after the procedure. Subject 2 developed a mild femoral
venous pseudoaneurysm after the ASD closure, which resolved with
mechanical compression. Subject 3 was noted to have an esophageal injury
after the procedure. Post-procedural CT scan revealed no air in the
mediastinum and the injury resolved after 1 day. She was nursed in the
hospital until she tolerated solid food orally. No device embolization
noted. All patients demonstrated left to right shunting across the
fenestrated atrial septal occlude immediately post closure. On further
follow-up, the fenestration closed gradually, by 6 months follow-up,
none of the fenestration flow persisted when interrogated via
transesophageal echocardiogram. Subject 6 still had a fenestration flow
at last follow-up, which was a little over 3 months after the ASD
closure. Given more time, the fenestration is likely to close off
spontaneously.
Patients who underwent ASD and LAA closure in the same setting (Group 1)
were compared with patients 1 and 6 (Group 2) who underwent the
procedures separately. The total duration and cost of the procedures
were shorter in Group 1 compared to Group 2 (82 minutes vs. 136.5
minutes and USD 12,869.76 vs. USD 13,598.46). The average length of
hospital stay in Group 1 was also shorter than Group 2 (4.5 days vs. 7
days). The total cost and hospital stay included those taken to treat
the venous pseudoaneurysm and esophageal injuries, sustained by patients
2 and 3, who were both in Group 1.