Title : Investigating the long-term follow up of atrial septal device closures in wales and england: A comparative analysis with major adverse cardiovascular Events (MACE)
Abstract:
Background: Atrial Septal Defects (ASDs) are common congenital heart defects, affecting nearly 25% of children. Larger ASDs may require device closure to prevent complications such as pulmonary hypertension and hypoxia. Evidence on long-term outcomes and adverse events after closure remains limited. This audit aimed to investigate correlations between device type/size and the incidence of Major Adverse Cardiovascular Events (MACE).
Methods: Using consented patient lists and the Welsh Clinical Portal, we reviewed all patients who underwent ASD device closure between 2000–2010 in Wales and England. After excluding cases with unidentifiable NHS numbers, 290 patients (173 females, 117 males) were included. Demographics, device type/size, and MACE outcomes (non-fatal stroke, MI, death, rhythm disturbance, cardiac admission) were recorded.
Results: The largest cohort was aged 21–30 years (n=119). Common devices were Amplatzer (n=123), PFO Biostar (n=32), and PFO Premer (n=8). Device sizes ranged 2–35 mm, with 23 mm (18.7%) most frequent. MACE included rhythm disturbance (34.8%), death (23.2%), cardiac admission (20.3%), stroke (14.5%), and MI (7.2%). Although the 29 mm device showed the highest MACE rate, no clear size–event correlation emerged. The Amplatzer device had the highest absolute number of MACE events, likely reflecting its more frequent use.
Conclusion: Our audit highlights substantial long-term morbidity following ASD closure, but no definitive association between device size/type and MACE. Larger datasets and extended follow-up are needed to identify risk factors and refine device selection guidelines.
