Abstract 3033: Beating-Heart Closure of Atrial Septal Defects with Complex Geometry: Real-time Three-Dimensional Echocardiography-Guided Hybrid Approach
Background: Application of transcatheter device closure of atrial septal defects (ASD) is limited by defect geometry and need for over-sizing to ensure complete closure. We have developed a catheter based patch delivery device and mini anchors for tissue attachment that can be delivered and fixed using real-time 3D echo (RT3DE). We sought to evaluate the efficacy of this system in closure of ASDs with complex geometry, which was not suitable for current device closure.
Methods: In Yorkshire pigs (n=3), using cardiopulmonary bypass (CPB), 12–15 mm ASDs without a rim on one side were created in 3 different locations: superior, inferior and posterior atrial septum. After the heart was closed and the animals were weaned from CPB, the ASDs were then closed using RT3DE guidance alone. The patch delivery device was introduced through the right atrial appendage and fixed around the border of the ASD using the Nitinol anchors.
Results: Two different patch delivery systems, concave and flat or planar, were used, depending on ASD geometry and location. In areas were a defect rim was not present, the patch was able to be fixed to the atrial free-wall using the anchors. No residual shunting was confirmed by 2D and 3D Color Doppler and by post-mortem examination. No surrounding anatomical structures were compromised.
Conclusions: Beating-heart closure of ASDs with complex geometry can be successfully completed using a catheter-based patch delivery system, with Nitinol tissue anchors for fixation, under RT3DE guidance. This hybrid approach may be a superior alternative to open-heart surgical closure and percutaneous transcatheter device closure of complex ASDs.