What is the mortality rate of device (percutaneous) closure?

Mortality Rate of Percutaneous Device Closure

The mortality rate of percutaneous device closure is close to zero in patients without pulmonary hypertension, with traditional operative strategies demonstrating excellent safety profiles. 1

Device Closure for Different Conditions

Atrial Septal Defect (ASD) Closure

Percutaneous device closure has become the preferred treatment method for secundum ASDs with suitable anatomy over the past three decades, demonstrating excellent safety and efficacy:

• Mortality rate: Near zero in patients without pulmonary hypertension 1
• Success rate: Approximately 100% in appropriate candidates 2
• Major complications: 1.5-1.6% 1, 2
• Minor complications: 6-7% 1, 2

The American Heart Association indicates that transcatheter secundum ASD closure is indicated in patients with hemodynamically significant ASD with suitable anatomic features (Class I recommendation) 1.

Patent Foramen Ovale (PFO) Closure

For PFO closure in patients with paradoxical embolism:

• Procedural success: Achieved in 100% of patients in some studies 3
• Major complications: 1.5-2.3% 1
• Minor complications: 7.9% 1
• Annual risk of recurrent neurological events: 0.9% 3

Ventricular Septal Defect (VSD) Closure

Percutaneous closure of VSDs shows:

• Closure rate: 97-97.5% 4
• Major complications: 1.2-2.2% 4
• Complete atrioventricular block: Reported in 1% of subjects 4

Post-Myocardial Infarction VSD Closure

This represents a higher-risk scenario:

• Success rate: Approximately 88% 4
• Mortality rate: 22-71% 4, 5

Factors Affecting Mortality

Several factors can influence mortality rates:

1. Patient age: Elderly patients (>60 years) may have slightly higher complication rates but similar survival compared to younger patients 1

2. Presence of pulmonary hypertension: Significantly increases risk

3. Type of defect:

   • Secundum ASDs have the lowest mortality
   • Post-MI VSDs have the highest mortality

4. Clinical presentation:

   • Cardiogenic shock
   • Inferior wall MI with VSR
   • Serpigenous form of VSR These factors are associated with poorer outcomes 5

Common Complications

1. Device-related:

   • Migration/embolization (0.9-1.8%) 2, 6
   • Erosion/perforation (rare) 2
   • Thrombus formation (0.9%) 6

2. Cardiac:

   • Arrhythmias (6.3-15.5%) 6
   • Heart block (1%) 4
   • Pericardial effusion/tamponade (0.9%) 3

3. Other:

   • Vascular access complications
   • Allergic reactions to medications

Pitfalls and Caveats

1. Patient selection is critical:

   • Ensure appropriate anatomic features for device closure
   • Secundum ASDs with suitable rim size are ideal candidates
   • Device closure should be avoided in patients with Eisenmenger physiology (Class III recommendation) 1

2. Device-specific considerations:

   • No device specific for PFO closure after cryptogenic stroke has FDA approval 1
   • Different devices have different size limitations and complication profiles

3. Long-term monitoring:

   • Progressive improvement in full occlusion occurs over time (44% at day 1 to 71% at 2 years) 3
   • Reintervention may be required in approximately 3.6% of cases 3

In summary, percutaneous device closure demonstrates excellent safety with mortality rates approaching zero for ASD closure in appropriately selected patients without pulmonary hypertension. However, mortality increases significantly in high-risk scenarios such as post-MI VSR closure.