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Zimmermann et al. Vessel Plus 2019;3:31 Vessel Plus
DOI: 10.20517/2574-1209.2019.010

Review Open Access

Atrial septal defect repair in the age of transcatheter
devices

Eric Zimmermann¹, Hafiz Hussain², Berhane Worku³, Dimitrios Dougenis , Dimitrios Avgerinos³
4
1 Department of Surgery, NewYork-Presbyterian/Queens, New York, NY 11355, USA.
2 Department of Cardiology, NewYork-Presbyterian/Queens, New York, NY 11355, USA.
3 Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian, New York, NY 10065, USA.
4 Department of Cardiac Surgery, National and Kapodistrian University of Athens, Athens 15772, Greece.

Correspondence to: Dr. Dimitrios Avgerinos, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York
Presbyterian, New York, NY 10065, USA. E-mail: dva9001@med.cornell.edu

How to cite this article: Zimmermann E, Hussain H, Worku B, Dougenis D, Avgerinos D. Atrial septal defect repair in the age of
transcatheter devices. Vessel Plus 2019;3:31. http://dx.doi.org/10.20517/2574-1209.2019.010

Received: 16 Apr 2019 First Decision: 15 Jul 2019 Revised: 16 Aug 2019 Accepted: 26 Aug 2019 Published: Sep 5 2019
Science Editor: Mario F. L. Gaudino Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
The aim of this review is to discuss the management of atrial septal defects (ASD) in the adult patient paying special
attention to the elderly population and the most recent transcatheter advancements. ASDs are characterized by the
following categories: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects; though multiple
defects may exist concurrently. Intervention for closure of ASDs are indicated with the development of right ventricular
volume overload, or in the clinical context of paradoxical embolic stroke. Previously, there was significant disagreement
regarding the timing of ASD closure in adult patients, but there is now general consensus that adult patients with clinical
evidence of right ventricular overload should undergo closure of ASDs at the time of presentation. The present review
describes the typical presentation of patients with symptomatic ASD’s, medical management, and whether surgical or
percutaneous approach should be pursued. We will also discuss other important considerations for patient selection and
potential early and late complications of transcatheter ASD closure such as congestive heart failure, device embolization,
and tissue erosion. At the time of this writing, there are currently three FDA-approved devices for percutaneous
TM
TM
VSD closure including the Amplatzer Septal Occluder (ASO, St. Jude Medical, St. Paul, MN), Gore HELEX Septal
TM
Occluder (W.L. Gore and Associates, Newark, NJ), and Gore CARDIOFORM Septal occluder (GCSO, W.L. Gore and
Associates, Newark, NJ) devices. Many premarket approvals were granted for devices that never went to market due
to poor investigational study performance. Likewise, the HELEX device has since been discontinued upon bringing the
GCSO device to market. We will focus primarily on the ASO device with a brief review of current investigations into the
GCSO device, both of which carry an indication for closure small to medium sized ASDs in the ostium secundum position.
Additionally, this review covers the safety of transcatheter closure of ASDs with currently available devices, review
studies associated with devices available outside the United States, and perioperative considerations for transcatheter

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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