Interventional Closure of Atrial Septal Defects with Deficient Rims: How Safe Is the Gore CARDIOFORM ASD Occluder?

Background: Interventional device closure has become the treatment of choice for hemodynamically significant atrial septal defects (ASDs). Because of the increased risk of embolization and erosion these procedures remain to be a challenge in patients with deficient rims.

Method: Over the last 9 months, interventional ASD closure using the Gore CARDIOFORM ASD Occluder was performed in eight patients with deficient rims. Age ranged from 4.9 to 53.7 years (mean: 7.2 years) and weight ranged from 15 to 76 kg (mean: 26 kg). The defect diameter measured 10 to 25 mm (mean: 15 mm) in transesophageal echocardiogram and 11 to 34 mm (mean: 18 mm) during balloon sizing. Three patients also had a mal-attached septum primum. Five patients had a deficient retroaortic rim (≤4 mm) including two without any retroaortic borders, and four patients had a deficient posterior rim (≤4 mm).

Results: Interventional ASD closure using the GORE CARDIOFORM ASD Occluder was successful in all patients. Procedure time ranged from 45 to 105 minutes (mean: 65 minutes). Fluoroscopy time was 0.3 to 16 minutes (mean: 3 minutes). There were no significant postprocedural shunts. No complications occurred. All patients were discharged home 2 days after the procedure.

Conclusion: Interventional ASD closure in patients with deficient rims using the GORE CARDIOFORM ASD Occluder is safe and effective. Because of its specific design the occluder aligns to its surroundings structures without distorting them. Still, larger studies and longer follow up are needed.

Publication History

Article published online:
28 January 2023