AUTHOR=Haddad Raymond N. , Kaddoura Rachid , Kasem Mohamed , Alsoufi Mahmoud 

TITLE=FAST technique: fast atrial sheath traction technique for device closure of atrial septal defects

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1155142

DOI=10.3389/fcvm.2023.1155142

ISSN=2297-055X

ABSTRACT=Background: Transcatheter closure of atrial septal defects (ASDs) is well-established. However, the procedure can be challenging, requiring multiple attempts and advanced implantation maneuvers.
Methods: From July 2019 to July 2022, patients to whom the fast atrial sheath traction (FAST) technique was applied for ASD device closure were prospectively followed up. The device was unsheathed rapidly in the middle of the left atrium to let the device clamp the ASD from both sides simultaneously. This novel technique was directly applied in patients with absent aortic rims and/or ASD size-to-body weight ratio higher than 0.9 or after failed standard implantation attempts.
Results: Seventeen patients (64.7% males) were involved with a median age of 9.8 years (IQR, 7.6-15.1), and a median weight of 34 kg (IQR, 22-44). The median ASD size on ultrasound was 19 mm (IQR, 16-22). Five (29.4%) patients had absent aortic rims. Three (17.6%) patients had an ASD size-to-body weight ratio higher than 0.9. The median device size was 22 mm (IQR, 17-24). The median difference between device size and ASD 2-dimensional static diameter was 3 mm (IQR, 1-3). All interventions were straightforward without any complications using three different occluder devices. One device was removed before release and upsized to the next size. The median fluoroscopy time was 4.1 min (IQR, 3.6-4.6). All patients were discharged the next postoperative day. On a median follow-up of 13 months (IQR, 8-13), no complications were detected. All patients achieved full clinical recovery with complete shunt closure.
Conclusions: We present a new implantation technique to efficiently close simple and complex ASDs. FAST technique can be helpful to overcome left disc malalignment to the septum in defects with absent aortic rims and avoid complex implantation maneuvers and the risks of injuring the pulmonary veins.