Surgical Management of Embolised Occluding ASD Closure Devices and its Complications

Abstract

Introduction: It is a retrospective study of the surgical management of embolized occluding devices following transcatheter closure of ostium secundum atrial septal defects (ASDs) at a single center over a 10-year period from January 2016 to January 2026.
Materials and Method: Out of 231 patients who underwent percutaneous ASD closure, 46 (aged 6–44 years; 25 females, 21 males) experienced device embolization, detected primarily via post-procedure echocardiography, necessitating emergency surgical intervention. All procedures involved midline sternotomy under cardiopulmonary bypass for device retrieval and ASD closure, typically with a pericardial patch.
Device embolization sites included the right atrium (24 cases), right ventricle (12 cases), left atrium (8 cases), and pulmonary artery (2 cases), with associated complications such as pericardial tamponade (5 cases), femoral artery thrombosis (4 cases), and transient ischemic attack (1 case). Successful retrieval and defect closure were achieved in all patients. The mean ICU stay was 2 days, and the mean hospital stay was 7 days, indicating good postoperative recovery in uncomplicated cases.
Discussion: Percutaneous ASD closure offers significant benefits but carries a risk of embolization (up to 3.5% in literature), often requiring prompt surgical correction to mitigate life-threatening sequelae. Proper patient selection, device sizing, and operator experience are crucial to minimize such events, with surgical outcomes demonstrating low morbidity when addressed urgently. This study underscores the value of hybrid approaches in managing ASDs while highlighting the need for vigilant monitoring post-device deployment.
Conclusion: Device embolization following percutaneous ASD closure remains a serious but manageable complication. When embolization occurs, prompt surgical intervention with device retrieval and definitive closure of the septal defect yields favorable outcomes with acceptable morbidity and mortality rates. Meticulous patient selection, appropriate device sizing, and adherence to institutional protocols are essential to minimize the incidence of this complication. This 10-year experience demonstrates that a hybrid approach— combining the benefits of transcatheter technique with surgical expertise for complication management—provides the best outcomes for patients with complex ASDs.
Note - All necessary ethical approval and informed patient consent has been obtained for this study.