Can Atrial Septal Defect (ASD) closure be performed on a beating heart?

From the Guidelines

Yes, ASD closure can be done on a beating heart, and this approach is recommended for eligible patients with secundum ASDs, as it offers a minimally invasive alternative to traditional open-heart surgery. This method, known as percutaneous transcatheter closure, allows the defect to be closed without stopping the heart or using cardiopulmonary bypass 1. The procedure involves inserting a catheter through a vein in the groin and guiding it to the heart, where a closure device, typically a double-disk occluder made of nitinol mesh, is deployed to seal the defect.

Key Considerations

• The procedure is performed under fluoroscopic and echocardiographic guidance to ensure proper placement 1.
• This technique is suitable for secundum ASDs with adequate rims and appropriate size (generally less than 38mm) 1.
• Patients typically require antiplatelet therapy (usually aspirin 75-100mg daily) for 6 months following the procedure to prevent thrombus formation while the device endothelializes.
• The beating heart approach offers advantages including shorter hospital stays, faster recovery, and avoidance of sternotomy and cardiopulmonary bypass complications.

Patient Selection

• Not all ASDs are suitable for this technique; larger defects or those with insufficient rims may still require traditional open-heart surgery 1.
• The decision to perform ASD closure on a beating heart should be made on a case-by-case basis, taking into account the individual patient's anatomy, symptoms, and overall health status 1.

Recommendations

• Transcatheter or surgical closure is recommended for adults with isolated secundum ASD causing impaired functional capacity, right atrial and/or RV enlargement, and net left-to-right shunt sufficiently large to cause physiological sequelae 1.
• Echocardiographic imaging is recommended to guide percutaneous ASD closure 1.

From the Research

ASD Closure in Beating Heart

• ASD closure can be performed in a beating heart using percutaneous or intra-operative device closure techniques 2.
• The percutaneous closure of a single secundum atrial septal defect (ASD) under transesophageal echocardiography guidance has been proven to be an accepted alternative to transcatheter closure with fluoroscopy 2.
• Studies have shown that percutaneous device closures of secundum atrial septal defects are safe and highly efficient in patients under guidance by transesophageal echocardiography, especially suited for women and children 2.
• Pre-procedural planning for percutaneous atrial septal defect closure can be done using transesophageal echocardiography or cardiac computed tomographic angiography, with the latter being more accurate in large defects with deficient inferior rims 3.
• Percutaneous ASD closure is commonly performed not only for children but also for adults, given its non-inferiority to surgical repair, and the choice of closure technique should be based on assessing a patient's baseline comorbidities and anatomical features 4.

Key Considerations

• Defect size, presence of adequate rim tissue, relationship to other cardiac structures, and associated congenital anomalies are important variables in determining the safety and efficacy of percutaneous ASD closure 3.
• The progressive impact of volume overload of the right cardiac chambers can be halted by ASD closure, making it an important treatment option for patients with ASDs 5.
• Combined transcatheter closure of atrial septal defect and pulmonary valve balloon dilation is a possible alternative to surgical correction in patients with critical pulmonary valve stenosis and ASD 6.