Since the 2000s, transcatheter closure has been the primary treatment for ostium secundum atrial septal defect (osASD) in children and adults.

This study aims to identify factors associated with short-term adverse outcomes following this procedure in a large cohort.

A prospective, single-center cohort study included 2,253 consecutive patients (median age 28years; children: n=865, 38.4%) who underwent transcatheter ASD closure with the Amplatzer Septal Occluder (ASO; Amplatzer™ Atrial Septal Occluder Device, Abbott, Chicago, USA) from May 1998 to December 2021. Peri-procedural data associated with major adverse events were investigated retrospectively.

The mean ASD diameter, as measured by transthoracic echocardiography, was 18mm. About 8.9% of patients had an ASD size-to-body surface area (BSA) ratio of≥20mm/m². Deficient rims (<5mm) were identified in 27.9% of patients, with retroaortic rim deficiency in 22.7% and inferior rim deficiency in 0.9%. The median ASO diameter was 24mm, with a procedural success rate of 98.2%. ASD/BSA≥20mm/m² was associated with procedural failure, while age and weight were not. Major peri-procedural adverse events occurred in 31 patients (1.4%), with 19 device embolizations and 2 cardiac erosions. No peri-procedural deaths were reported. Multivariate analysis showed that deficiency of the inferior vena cava rim and an ASD size/BS ratio≥20mm/m² were significantly associated with major adverse events (P=0.002 and P=0.035, respectively) (Fig. 1).

Transcatheter osASD closure using ASO is safe and effective in a large spectrum population with low rate of peri-procedural adverse events and favorable short-term outcomes. ASD size-to-body surface area ratio (≥20mm/m²) and inferior rim deficiency are key morphological risk markers for major adverse events following this procedure.