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  • Title: Iatrogenic atrial septal defect persistence after percutaneous mitral valve repair: a meta-analysis.
    Author: Maier O, Hellhammer K, Horn P, Afzal S, Jung C, Westenfeld R, Zeus T, Kelm M, Veulemans V.
    Journal: Acta Cardiol; 2022 Apr; 77(2):166-175. PubMed ID: 34085598.
    Abstract:
    BACKGROUND: Percutaneous mitral valve repair (PMVR) requires a puncture of the atrial septum, resulting in iatrogenic atrial septal defect (iASD), which usually causes a transient left-to-right shunt. However, the influencing risk factors for iASD persistence and functional consequences are not fully understood. This meta-analysis aimed to summarise available data on the persistence of iASD following PMVR. METHODS: The authors conducted a literature search in PubMed/MEDLINE and EMBASE databases to identify studies investigating iASD persistence in PMVR patients. RESULTS: Six observational studies (n = 361) met inclusion criteria for the final analysis. Prevalence of persistent iASD was documented with 28% after 12 months follow-up. iASD size increased over time with a diameter of 5.3 ± 0.76 mm after one month and 6.5 ± 0.21 mm after 12 months. Possible predictors of iASD persistence after PMVR appeared to be pre-existing AF (RR 1.24; p = .03), residual mitral regurgitation > II° (RR 2.06; p = .03) and prolonged fluoroscopic time (RR 8.27; p = .01). Patients with iASD persistence had a higher risk for development of right heart overload regarding the increased area of the right atrium (MD 5.24; p = .004) and enlarged diameter of the right ventricle (MD 3.33; p < .0001). Rehospitalization was more frequently reported in iASD patients (RR 9.52; p = .004). CONCLUSIONS: This meta-analysis proved iASD persistence in 28% of PMVR after 12 months follow-up with a higher risk for right heart volume overload and more frequent rehospitalization compared to patients without iASD persistence. Since percutaneous catheter-based treatments with transseptal approaches are rising, further evidence about the hemodynamic impact of persistent iASD is warranted.
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