Author + information
- Ravinay Bhindi, MBBS, PhD, FRACP, FESC⁎ ( and )
- Oliver J. Ormerod, DM, FRCP
- ↵⁎Cardiology Department, John Radcliffe Hospital, Headley Way, Headington, Oxfordshire OX3 9DU, United Kingdom
We read with interest the expedited review by Jones et al. (1) which details multicenter experience with the Helex Septal Occluder device (W. L. Gore and Associates, Flagstaff, Arizona) for the percutaneous closure of secundum atrial septal defects (ASD). The investigators report a favorable experience with the device relative to surgical closure in terms of length of hospital stay and duration of anesthesia, with equivalence in the primary end point of the study, which was “clinical success.” At Oxford we have used the Helex device for over 3 years for both patent foramen ovale (PFO) and ASD closures with 2 dedicated operators. Since June 2006 we have used the Helex device to close secundum ASDs in 38 patients successfully with no significant adverse events. A key point of difference is the markedly lower procedural time and fluoroscopy time in our cohort compared with the reported study (average fluoroscopic time 7.4 vs. 28 min, respectively; total time under anesthesia 49.4 vs. 160 min, respectively). In fact, our low fluoroscopy times have enabled us to close PFOs using the Helex device rapidly and safely in pregnancy (2).
It is unclear why this difference is apparent. We now routinely use intracardiac echocardiography (ICE) during the procedure, which has resulted in a reduction in procedural time by avoiding the need for general anesthesia, which is often required if transesophageal echocardiography is used, and has allowed same-day discharge of these patients. The proportion of patients in the reported study that underwent the procedure with adjunctive ICE is not reported, and whether this is a factor in the disparity observed in both procedural and fluoroscopy times is not known but could indeed play a role. Certainly, our single-center dedicated-operator experience using ICE to close secundum ASDs with the Helex device has yielded low procedural and fluoroscopy times with excellent results and no significant adverse events. In centers using this device, operator familiarity and ICE could help in optimizing procedural times.
- American College of Cardiology Foundation