Catheterization and Cardiovascular Interventions

ORIGINAL ARTICLE - CLINICAL SCIENCE

Sex-Specific Outcomes in Patients Undergoing Transcatheter Closure of Atrial Septal Defects: Do They Benefit Equally?

Lore Schrutka

orcid.org/0000-0002-2731-2667

Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria

Search for more papers by this author

Lusine Abrahamyan,

Lusine Abrahamyan

Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Ontario, Canada

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Search for more papers by this author

Varnita Vishwanath,

Varnita Vishwanath

orcid.org/0000-0003-0913-9087

Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA

Search for more papers by this author

Eduardo Flores-Umanzor,

Eduardo Flores-Umanzor

orcid.org/0000-0002-6428-241X

Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain

Search for more papers by this author

Areeba Asghar,

Areeba Asghar

orcid.org/0000-0003-1545-709X

Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Ontario, Canada

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada

Search for more papers by this author

Lee Benson,

Lee Benson

orcid.org/0000-0002-1407-1825

The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Search for more papers by this author

Mark D. Osten,

Mark D. Osten

Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

Search for more papers by this author

Eric M. Horlick,

Corresponding Author

Eric M. Horlick

[email protected]

Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

Correspondence: Eric M. Horlick ([email protected])

Search for more papers by this author

Lore Schrutka,

Lore Schrutka

orcid.org/0000-0002-2731-2667

Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria

Search for more papers by this author

Lusine Abrahamyan,

Lusine Abrahamyan

Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Ontario, Canada

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Search for more papers by this author

Varnita Vishwanath,

Varnita Vishwanath

orcid.org/0000-0003-0913-9087

Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA

Search for more papers by this author

Eduardo Flores-Umanzor,

Eduardo Flores-Umanzor

orcid.org/0000-0002-6428-241X

Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

Cardiology Department, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain

Search for more papers by this author

Areeba Asghar,

Areeba Asghar

orcid.org/0000-0003-1545-709X

Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Ontario, Canada

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada

Search for more papers by this author

Lee Benson,

Lee Benson

orcid.org/0000-0002-1407-1825

The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Search for more papers by this author

Mark D. Osten,

Mark D. Osten

Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

Search for more papers by this author

Eric M. Horlick,

Corresponding Author

Eric M. Horlick

[email protected]

Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

Correspondence: Eric M. Horlick ([email protected])

Search for more papers by this author

First published: 01 May 2025

https://doi.org/10.1002/ccd.31561

Lore Schrutka and Lusine Abrahamyan Contributed equally to this study.

Share a link

Email
Wechat
Bluesky

ABSTRACT

Background

Sex differences in congenital heart disease are known to effect outcomes, however, there is limited data on its role in atrial septal defect (ASD) closure.

Aims

We aimed to investigate sex differences in baseline characteristics, procedural and long-term outcomes of patients who underwent transcatheter ASD closure.

Methods

This single-center, retrospective cohort study enrolled adult patients undergoing ASD closure between 2005 and 2016 at the Toronto General Hospital, Canada. Information on index procedure and follow-up was extracted from the hospital medical records.

Results

Of the 853 patients included, 281 (32.9%) were male and 572 (67.1%) were female. Females more frequently presented with dyspnea or palpitations, whereas males had more cardiovascular comorbidities. More males presented with right ventricular (RV) dysfunction than females. Females had higher RV systolic pressures and a higher prevalence of moderate-to-severe tricuspid regurgitation (TR). Procedure-related complications were rare and not different by sex. At 12-month follow-up, both males and females showed comparable decreases in RV diameter, RV systolic pressure, and TR severity. After a mean follow-up of 3 years (SD = 5), no significant differences were observed in the incidence of death (adjusted hazard ratio (HR) = 1.48 [95% CI 0.38−5.74]; p = 0.57), need for cardioversion or ablation, cerebrovascular events, and pacemaker implantation. Females had a lower hazard of new-onset atrial fibrillation than males (HR = 0.63 [95% CI 0.41−1.00]; p = 0.05).

Conclusion

Although patient profiles differed by sex, procedural and long-term outcomes were comparable, suggesting that females and males benefit equally from transcatheter ASD closure.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

References

1D. van der Linde, E. E. M. Konings, M. A. Slager, et al., “Birth Prevalence of Congenital Heart Disease Worldwide,” Journal of the American College of Cardiology 58, no. 21 (November 2011): 2241–2247, https://doi.org/10.1016/j.jacc.2011.08.025.
10.1016/j.jacc.2011.08.025
PubMed Web of Science® Google Scholar
2M. Brida, M. Chessa, D. Celermajer, et al., “Atrial Septal Defect in Adulthood: A New Paradigm for Congenital Heart Disease,” European Heart Journal 43, no. 28 (July 2022): 2660–2671, https://doi.org/10.1093/eurheartj/ehab646.
10.1093/eurheartj/ehab646
PubMed Web of Science® Google Scholar
3T. Geva, J. D. Martins, and R. M. Wald, “Atrial Septal Defects,” The Lancet 383, no. 9932 (May 2014): 1921–1932, https://doi.org/10.1016/s0140-6736(13)62145-5.
10.1016/S0140-6736(13)62145-5
PubMed Web of Science® Google Scholar
4K. K. Stout, C. J. Daniels, J. A. Aboulhosn, et al., “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” Circulation 139, no. 14 (April 2019): e637–e697, https://doi.org/10.1161/CIR.0000000000000602.
10.1161/CIR.0000000000000602
PubMed Web of Science® Google Scholar
5C. A. Warnes, “Sex Differences In Congenital Heart Disease: Should a Woman be More Like a Man?,” Circulation 118, no. 1 (July 2008): 3–5, https://doi.org/10.1161/CIRCULATIONAHA.108.785899.
10.1161/CIRCULATIONAHA.108.785899
PubMed Web of Science® Google Scholar
6P. Engelfriet and B. J. M. Mulder, “Gender Differences in Adult Congenital Heart Disease,” Netherlands Heart Journal 17, no. 11 (November 2009): 414–417, https://doi.org/10.1007/bf03086294.
10.1007/BF03086294
CAS PubMed Web of Science® Google Scholar
7C. L. Verheugt, C. S. P. M. Uiterwaal, E. T. van der Velde, et al., “Gender and Outcome in Adult Congenital Heart Disease,” Circulation 118, no. 1 (July 2008): 26–32, https://doi.org/10.1161/circulationaha.107.758086.
10.1161/CIRCULATIONAHA.107.758086
PubMed Web of Science® Google Scholar
8A. C. Zomer, R. Ionescu-Ittu, I. Vaartjes, et al., “Sex Differences in Hospital Mortality in Adults With Congenital Heart Disease,” Journal of the American College of Cardiology 62, no. 1 (July 2013): 58–67, https://doi.org/10.1016/j.jacc.2013.03.056.
10.1016/j.jacc.2013.03.056
PubMed Web of Science® Google Scholar
9T. Podnar, P. Martanovič, P. Gavora, and J. Masura, “Morphological Variations of Secundum-Type Atrial Septal Defects: Feasibility for Percutaneous Closure Using Amplatzer Septal Occluders,” Catheterization and Cardiovascular Interventions 53, no. 3 (July 2001): 386–391, https://doi.org/10.1002/ccd.1187.
10.1002/ccd.1187
CAS PubMed Web of Science® Google Scholar
10J. N. Johnson, M. L. Marquardt, M. J. Ackerman, et al., “Electrocardiographic Changes and Arrhythmias Following Percutaneous Atrial Septal Defect and Patent Foramen Ovale Device Closure,” Catheterization and Cardiovascular Interventions 78, no. 2 (August 2011): 254–261, https://doi.org/10.1002/ccd.23028.
10.1002/ccd.23028
PubMed Web of Science® Google Scholar
11M. A. Kotowycz, J. Therrien, R. Ionescu-Ittu, et al., “Long-Term Outcomes After Surgical Versus Transcatheter Closure of Atrial Septal Defects in Adults,” JACC: Cardiovascular Interventions 6, no. 5 (May 2013): 497–503, https://doi.org/10.1016/j.jcin.2012.12.126.
10.1016/j.jcin.2012.12.126
PubMed Web of Science® Google Scholar
12J. M. Kuijpers, T. van der Bom, A. C. M. J. van Riel, et al., “Secundum Atrial Septal Defect Is Associated With Reduced Survival in Adult Men,” European Heart Journal 36, no. 31 (August 2015): 2079–2086, https://doi.org/10.1093/eurheartj/ehv097.
10.1093/eurheartj/ehv097
PubMed Web of Science® Google Scholar
13C. Nyboe, Z. Karunanithi, J. E. Nielsen-Kudsk, and V. E. Hjortdal, “Long-Term Mortality in Patients With Atrial Septal Defect: A Nationwide Cohort-Study,” European Heart Journal 39, no. 12 (March 2018): 993–998, https://doi.org/10.1093/eurheartj/ehx687.
10.1093/eurheartj/ehx687
PubMed Web of Science® Google Scholar
14R. J. R. Snijder, L. E. Renes, D. Bosshardt, M. J. Suttorp, J. M. Ten Berg, and M. C. Post, “Percutaneous Atrial Septal Defect Closure Using the Occlutech Figulla Device in Adults: More Than 800 Patient-Years of Follow-Up,” Journal of Interventional Cardiology 2020 (2020): 7136802, https://doi.org/10.1155/2020/7136802.
10.1155/2020/7136802
CAS PubMed Web of Science® Google Scholar
15H. Baumgartner, J. De Backer, S. V. Babu-Narayan, et al., “2020 ESC Guidelines for the Management of Adult Congenital Heart Disease,” European Heart Journal 42, no. 6 (February 2021): 563–645, https://doi.org/10.1093/eurheartj/ehaa554.
10.1093/eurheartj/ehaa554
CAS PubMed Web of Science® Google Scholar
16A. Marelli, L. Beauchesne, J. Colman, et al., “Canadian Cardiovascular Society 2022 Guidelines for Cardiovascular Interventions in Adults With Congenital Heart Disease,” Canadian Journal of Cardiology 38 (April 2022): 862–896, https://doi.org/10.1016/j.cjca.2022.03.021.
10.1016/j.cjca.2022.03.021
PubMed Web of Science® Google Scholar
17K. K. Stout, C. J. Daniels, J. A. Aboulhosn, et al., “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines,” Circulation 139, no. 14 (April 2019): e698–e800, https://doi.org/10.1161/cir.0000000000000603.
10.1161/cir.0000000000000603
PubMed Web of Science® Google Scholar
18 R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. 2022. https://www.R-project.org/.
Google Scholar
19R. L. Benza, D. P. Miller, M. Gomberg-Maitland, et al., “Predicting Survival in Pulmonary Arterial Hypertension: Insights From the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL),” Circulation 122, no. 2 (July 2010): 164–172, https://doi.org/10.1161/circulationaha.109.898122.
10.1161/CIRCULATIONAHA.109.898122
PubMed Web of Science® Google Scholar
20M. Brida, G. P. Diller, A. Kempny, et al., “Atrial Septal Defect Closure in Adulthood Is Associated With Normal Survival in the Mid to Longer Term,” Heart 105, no. 13 (July 2019): 1014–1019, https://doi.org/10.1136/heartjnl-2018-314380.
10.1136/heartjnl-2018-314380
CAS PubMed Web of Science® Google Scholar
21C. Nyboe, M. S. Olsen, J. E. Nielsen-Kudsk, and V. E. Hjortdal, “Atrial Fibrillation and Stroke in Adult Patients With Atrial Septal Defect and the Long-Term Effect of Closure,” Heart 101, no. 9 (May 2015): 706–711, https://doi.org/10.1136/heartjnl-2014-306552.
10.1136/heartjnl-2014-306552
CAS PubMed Web of Science® Google Scholar

Volume106, Issue1

July 1, 2025

Pages 472-480

SCAI Member Sign in

Sex-Specific Outcomes in Patients Undergoing Transcatheter Closure of Atrial Septal Defects: Do They Benefit Equally?

ABSTRACT

Background

Aims

Methods

Results

Conclusion

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Sex-Specific Outcomes in Patients Undergoing Transcatheter Closure of Atrial Septal Defects: Do They Benefit Equally?

ABSTRACT

Background

Aims

Methods

Results

Conclusion

Conflicts of Interest

Open Research

Data Availability Statement

References

References

Related

Information