Long-term Complications After Transcatheter Atrial Septal Defect Closure: A Review of the Medical Literature

Percutaneous closure has evolved to become the first-line treatment strategy for most cases of secundum atrial septal defect (ASD) in both adults and children. Its safety and efficacy have been proved; percutaneous ASD occlusion offers many advantages over surgical closure, including avoidance of cardiopulmonary bypass, avoidance of sternotomy scar, shorter hospitalization, and a potentially lower incidence of postprocedural complications. Periprocedural course and short-term outcome have been widely described, with low mortality and morbidity rates. However, the wide use of ASD closure devices and the growing experience worldwide brought some delayed and rare complications to light. Device thrombosis and cardiac erosion are the most severe late complications of device closure, whereas atrial arrhythmias are the most common. Other delayed complications include nickel allergy, cardiac conduction abnormalities, valvular damage, and device endocarditis. The long-term complication rate is not null and, although rare, some of these complications may be sudden and potentially life-threatening. Moreover, the occurrence and rate of these complications vary with the different devices used currently or in the past. Therefore, both operators and patients need to be aware of these issues to assist them in the choice of intervention or device, or both, and to adapt follow-up modalities. In this review, we sought to describe the type, incidence, and outcome of these rare but potentially serious device closure delayed complications. La fermeture par voie percutanée est devenue la stratégie de traitement de première intention de la plupart des cas de communications interauriculaires (CIA) de type ostium secundum chez les adultes et les enfants. Son innocuité et son efficacité ont été démontrées; l’occlusion par voie percutanée de la CIA offre plusieurs avantages par rapport à la fermeture par voie chirurgicale, y compris l’évitement du pontage cardiopulmonaire, l’évitement de la cicatrice de sternotomie, l’hospitalisation plus courte et une fréquence potentiellement plus faible des complications postopératoires. L’évolution périopératoire et les résultats à court terme ont largement démontré de faibles taux de mortalité et de morbidité. Cependant, la vaste utilisation des dispositifs de fermeture de la CIA et l’expérience accumulée dans le monde entier ont mis en lumière quelques complications tardives et rares. La thrombose sur dispositif et l’érosion cardiaque sont les