Complications after Percutaneous Device Closure of Atrial Septal Defects in Children: Prevalence, Outcomes and Associated Factors

Atrial septal defects (ASDs) represent 10% of congenital heart disease. Transcatheter closure is the standard of care for anatomically suitable defects, but pediatric long-term outcomes remain underreported. This study examined the prevalence, outcomes, and risk factors for complications following ASD device closure in children. We retrospectively reviewed children <18 years undergoing transcatheter ASD closure at a single tertiary center (1989–2016). Demographic, procedural, and follow-up data were analyzed. Kaplan-Meier methods assessed freedom from major complications and associations with device type, imaging technique, and concomitant congenital heart disease (CHD). A total of 971 children (mean age 8.2 ± 4.2 years, 62% female) underwent closure, with median follow-up 2.2 years (maximum 20.7). Concomitant CHD was present in 33%. Major complications occurred in 1.6%, including device embolization (0.6%), erosion (0.4%), and urgent surgery (0.6%). Rates were highest with early-era devices (8%). Kaplan-Meier analysis showed freedom from major complications of 98.1% at 5 years and 97.6% at 10 years. No significant differences were observed by imaging modality (ICE vs. TEE) or presence of concomitant CHD. In this large pediatric cohort, transcatheter ASD closure was associated with low rates of major complications and excellent long-term outcomes. Neither concomitant CHD nor imaging technique significantly affected complication risk. These findings reinforce the long-term safety of ASD device closure in children. • A large pediatric cohort of atrial septal defect device closures with medium to long term follow-up • Major complication rate was low at 1.7% with excellent 10 year outcomes • Major complication risk did not differ by procedural imaging modality or concomitant congenital heart disease • Multiple defects were safely closed without increased complication risk • Findings reinforce sustained safety of ASD device closure in children