Iatrogenic atrial septal defect persistence after percutaneous mitral valve repair: a meta-analysis.

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 ( = 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;  = .03), residual mitral regurgitation > II° (RR 2.06;  = .03) and prolonged fluoroscopic time (RR 8.27;  = .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;  = .004) and enlarged diameter of the right ventricle (MD 3.33;  < .0001). Rehospitalization was more frequently reported in iASD patients (RR 9.52;  = .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.