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Original research
Transcatheter versus surgical closure of atrial septal defect in adult patients with tricuspid regurgitation
  1. Mijin Kim1,
  2. Pil Hyung Lee1,
  3. Dae-Hee Kim1,
  4. Sung-Ho Jung2,
  5. Seung-Ah Lee1,
  6. Sahmin Lee1,
  7. Duk-Hyun Kang1,
  8. Jae-Kwan Song1,
  9. Jong-Min Song1
  1. 1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
  2. 2Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
  1. Correspondence to Professor Jong-Min Song, Department of Cardiology, University of Ulsan College of Medicine, Songpa-gu Seoul 05505, Korea (the Republic of); jmsong{at}


Objectives Transcatheter closure using a device has been established as an effective atrial septal defect (ASD) treatment, but its value in treating patients with concomitant functional tricuspid regurgitation (TR) is relatively unknown. We sought to evaluate outcomes of patients with ASD and significant TR after transcatheter ASD closure or surgical treatment.

Methods A total of 252 consecutive adult patients (53.8±13.8 years, 180 females) who had a significant functional TR before ASD closure were retrospectively analysed. The primary end point was a composite of all-cause death, stroke and heart failure. The secondary end point was significant residual TR early and at 1 year after ASD closure.

Results Transcatheter ASD closure alone and surgical ASD closure along with tricuspid annuloplasty (TAP) were performed in 68 and 184 patients, respectively. Significant TR remained in 32% (81/252) early after ASD closure and in 29% (52/182) after 1 year. The severity of TR was significantly decreased after transcatheter ASD closure (p<0.001). In multivariable analysis, TAP (OR 0.07; p<0.001) and ASD diameter (OR 0.90; p=0.040) were independent predictors of the significant residual TR early after treatment, while only TAP (OR 0.08; p<0.001) was a significant predictor at 1 year after treatment. After propensity score matching in patients with moderate or severe TR, there were no significant differences between the transcatheter ASD closure group and surgical ASD closure plus TAP group in terms of the event rates at 5 years (10.3% vs 5.5%, p=0.963).

Conclusions While TAP was effective for the treatment of significant TR, transcatheter ASD closure also significantly reduced TR as well. Transcatheter ASD closure may be considered an alternative treatment option in patients with moderate or severe TR.

  • atrial septal defect
  • device closure
  • tricuspid valve insufficiency

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors J-MS designed the study. MK, PHL and J-MS analysed and interpreted the data, and also drafted the manuscript. D-HK, S-HJ, S-AL, SL, D-HK and J-KS revised the manuscript and approved the submission. MK and J-MS are responsible for the overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.