ORIGINAL CONTRIBUTION Single Tertiary Center Experience Using Gore Cardioform Atrial Septal Defect Occluder for Secundum Atrial Septal Defect Closure With a Focus on Deficient Rims

Background. The data on the use of Gore Cardioform Septal Occluder (GCA; W. L. Gore & Associates, Inc.) for atrial septal defect (ASD) with deficient rims is limited. Methods. All patients evaluated by transesophageal echocardiogram (TEE) for ASD occlusion were included. TEE planes at 35 degrees, 0 degrees, and 90 degrees were assessed for anterior -superior (AS) and posterior (P), anterior -inferior (AI) and posterior -superior (PS), as well as superior (S) and inferior (I) rims. ASD size >20 mm, and rims <5 mm were defined as large and deficient, respectively. We included patients who had a procedural failure along with the patients in whom the procedure was not attempted after echocardiogram in the unsuccessful group. Results. In 148 patients, the median weight, age, and ASD size were 36 kg (range, 8-60 kg), 11.8 years (range, 1-60 years), and 14.2 +/- 8.28 mm, respectively. One or more deficient rims were noted in 112 of 148 (75.7%): 99 (67%) AS, 36 (24%) P, 17 (11%) AI, 30 (20%) PS, 26 (18%) S, and 33 (22%) I. ASD closure was performed in 115 (78%) patients. The procedure was successful in 111 (96.5%) patients with procedural failure in 4 (3.4%) patients. Multiple deficient rims were associated with reduced procedural success (OR 0.36, 95% CI, 0.25-0.56). On multivariate analysis deficient P, PS, and I rims were associated with an unsuccessful group (P = .001, .046, and .005, respectively). Complications included 1 device embolization, 1 vascular injury, and 5 arrhythmias. Conclusions. Transcatheter closure of ASDs with deficient rims is feasible using GCA. Large ASDs with deficient P, PS, and I rims were associated with unsuccessful closure. Risk stratification and comprehensive evaluation of ASD rims is vital for the use of GCA.