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.