Abstract 2479: What is the Long-Term Outcome of Transseptal Puncture Using a 12-French Sheath?
Introduction: The transseptal puncture procedure has proven to be invaluable for a variety of interventions. Serial transesophageal echocardiography (TEE) studies after puncture with 8Fr sheaths have revealed that this residual atrial septal defect (ASD) eventually closes. However, there is no data on the integrity of the atrial septum after puncture with larger caliber sheaths - an important issue given the increasing use of large sheaths for electrophysiological and interventional procedures such AF ablation using balloon catheters, LAA occlusion and percutaneous valve procedures. To this end, this study examined atrial septal integrity after transseptal puncture using a 12-Fr sheath.
Methods: The study cohort included patients enrolled in PROTECT-AF, an investigational trial of left atrial appendage occlusion (Watchman, Atritech, Inc). The procedure involves use of a transseptal sheath with a 12Fr inner and 14Fr outer diameter. Systematic evaluation of the iatrogenic ASD was possible because the protocol mandated serial TEE evaluation at implant, 45 days, 6 months and 12 months. All data was evaluated by a central TEE core lab.
Results: TEE data was available for 373 pts, 323 pts, 375 pts, 324 pts and 238 pts at pre-procedure, post-procedure, 45d, 6mo and 12mo, respectively. The majority of the ASDs closed by 6months; a few additional ASDs closed beyond this timepoint (Table⇓). Of the persistent ASDs, color flow doppler revealed only left-to-right flow in the majority of patients chronically.
Conclusions: In most patients, the iatrogenic ASD closes even after transseptal puncture using a 12Fr sheath. And even when persistent, the trans-ASD flow is largely left-to-right.