279: The transcatheter closure of Atrial Septal Defect (ASD) in patients older than 60 years : Retrospective study of 41 cases

Introduction Transcatheter closure of ASD is now proposed as first line treatment for the elderly patients. Purpose The aim of our study is to evaluating the transcatheter closure of ASD in patients older than 60 years. Methods The records of 41 patients (37 women, 4 men) who are over 60 years (69.88±6 years, range 61-82 years), referred between April 1998 and December 2010 for transcatheter closure of secundum ASD, were retrospectively reviewed Results ASD was discovered during the assessment of patients with dyspnea (17) or arrhythmia (17). Average age at time of diagnosis was 62.4±14.89 years (range 14-82 years). 37.8% of cases had a delayed diagnosis. At time of the procedure, 19 patients (46.3%) had supraventricular arrhythmia and 82.9% of patients were dyspneic. Shunt ratio was 2.50±0.66, defect size 19.67±6.76 mm, stretched diameter 24.36 mm±5.87, device diameter of 24.49 mm±6.58. One patient was recused, because of increased left atrial pressure at occlusion test. Fluoroscopy time was 7.01±4.41 min. Success rate is 97.5%. Complete closure rate at one day and one month was 84.6% and 94.9% respectively. Systolic pulmonary pressure decreased from 49.37 to 34,58 mmHg at one month. Hospital stay was 3.58 days ± 2.71. Periprocedural complication rate was 12.2%. 2 complications were major: one death by esophageal hematoma, and one oropharyngeal bleeding, and 3 minors: 3 femoral arteriovenous fistulas. At late follow-up (34±44 months, range 1month to 12 years), 34 patients were in stage one, 4 recurred supraventricular arrhythmia, 1 needed pace maker for sinus node dysfunction. Conclusion Transcatheter closure of ASD in ederly patients is effective. It does not change rhythmic status but allows symptomatic improvement.