Background: The Amplatzer septal occluder (ASO) allows the percutaneous closure of small to very large atrial septal defects (ASDs). The CardioSEAL/STARflex (CS/SF) can be used only for closure of small to moderate ASDs (stretch size up to 18 mm). These 2 devices are widely used in clinical practice. Therefore, a comparison of their use in the closure of small to moderate ASDs is needed.
Methods: From December 1996 to September 2002, 274 consecutive patients (mean age 20.3 +/- 17 years) underwent percutaneous closure of small to moderate ostium secundum ASDs. The CS/SF device was used in 121 patients, and the ASO was used in 153.
Results: There were no differences in age, sex ratio, or pulmonary/systemic flow ratio. Stretch size of the defect was higher in the ASO group (13.6 +/- 3.5 mm vs 15.5 +/- 3.2 mm, P <.001). Procedure time and fluoroscopy time were shorter in patients treated with the ASO (61 +/- 21 vs 75 +/- 32 min, P <.0003, and 11.6 +/- 9 vs 23.8 +/- 17.4 min, P <.0001, respectively). Residual shunt at procedure and discharge was significantly more frequent in the CS/SF group (P <.0001). There were no differences in the complication rate for the 2 groups (CS/SF 4/121 vs ASO 6/153). Length of follow-up was longer in the CS/SF group (24 +/- 14 vs 16 +/- 9 months, P =.0001). Residual shunting was significantly more frequent in the CS/SF group during follow-up, while closure rate reached 100% after 1 month in ASO group.
Conclusions: The 2 devices are clinically safe and effective in ASD closure. However, percutaneous closure of small to moderate ASDs with ASO is quicker and provides an higher rate of complete occlusion.