Abbott offers two devices for percutaneous transcatheter ASD closure.
The AmplatzerTM Septal Occluder, FDA approved since 2001, is intended for patients with an ASD in the secundum position or patients who have undergone a fenestrated Fontan procedure and who now require closure of the fenestration.
The AmplatzerTM Septal Occluder has a wide connecting waist that centers the device and fills the ASD. This occluder—offering the widest range of ASD sizes—can treat defects from 3 mm to 38 mm.
The AmplatzerTM Cribriform Multifenestrated Septal Occluder is safe and effective for the closure of multifenestrated (cribriform) ASDs.1
Multiple, or fenestrated, ASDs that require closure are not uncommon; in fact nearly 10% of patients with secundum-type ASD are found to have multifenestrated ASDs.1
In many ways similar to the AmplatzerTM Septal Occluder, the AmplatzerTM Cribriform Occluder consists of 2 uniformly sized discs with a very small connecting waist. The waist allows the device to cover a much larger fenestrated area of the atrial septum. This occluder’s disc diameters range from 18 to 40 mm.
The AmplatzerTM Cribriform Occluder is effective in treating a multiple-fenestrated atrial septum.
Both types of AmplatzerTM Septal Occluders offer these unique features:
- Discs that are designed to securely appose the septal wall on each side of the defect
- Polyester material that promotes occlusion and tissue in-growth
- Ability to be recaptured and redeployed to ensure precise device placement
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- Cho MJ, et al. Transcatheter closure of multiple atrial septal defects with the AmplatzerTM device. Korean Circ J. 2011;41:549-551.
AMPLATZERTM SEPTAL OCCLUDER AND DELIVERY SYSTEM
INDICATION FOR USE
The AMPLATZERTM Septal Occluder is a percutaneous, transcatheter, atrial septal defect closure device intended for the occlusion of atrial septal defects (ASD) in secundum position or patients who have undergone a fenestrated Fontan procedure and who now require closure of the fenestration. Patients indicated for ASD closure have echocardiographic evidence of ostium secundum atrial septal defect and clinical evidence of right ventricular volume overload (such as, 1.5:1 degree of left-to-right shunt or RV enlargement).
The AMPLATZERTM Septal Occluder is contraindicated for the following:
- Any patient known to have extensive congenital cardiac anomaly which can only be adequately repaired by way of cardiac surgery.
- Any patient known to have sepsis within 1 month prior to implantation, or any systemic infection that cannot be successfully treated prior to device placement.
- Any patient known to have a bleeding disorder, untreated ulcer, or any other contraindications to aspirin therapy, unless another antiplatelet agent can be administered for 6 months.
- Any patient known to have a demonstrated intracardiac thrombi on echocardiography (especially left atrial or left atrial appendage thrombi).
- Any patient whose size (such as, too small for transesophageal echocardiography probe, catheter size) or condition (active infection, etc.) would cause the patient to be a poor candidate for cardiac catheterization.
- Any patient where the margins of the defect are less than 5 mm to the coronary sinus, inferior vena cava rim, AV valves, or right upper lobe pulmonary vein.
- Physicians must be prepared to deal with urgent situations, such as device embolization, which require removal of the device. This includes the availability of an on-site surgeon.
- Embolized devices must be removed as they may disrupt critical cardiac functions. Embolized devices should not be withdrawn through intracardiac structures unless they have been adequately collapsed within the sheath.
- Use on or before the expiration date noted on the product packaging.
- This device is sterilized using ethylene oxide and is for single use only. Do not reuse or resterilize. Attempts to resterilize the device may result in device malfunction, inadequate sterilization, or patient harm.
- Do not use the device if the packaging sterile barrier is open or damaged.
- Do not release the AMPLATZERTM Septal Occluder from the delivery cable if the device does not conform to its original configuration, or if the device position is unstable or if the device inter- feres with any adjacent cardiac structure (such as Superior Vena Cava (SVC), Pulmonary Vein (PV), Mitral Valve (MV), Coronary Sinus (CS), aorta (AO)). Recapture the device and redeploy. If still unsatisfactory, recapture the device and either replace with a new device or refer the patient for alternative treatment.
- Implantation of this device may not supplant the need for CoumadinTM in patients with ASD and paradoxical emboli.
- The use of echocardiographic imaging (TTE, TEE, or ICE) is required.
- Balloon sizing should be used to size the atrial septal defect using a stop-flow technique. Do not inflate the balloon beyond the cessation of the shunt (such as, stop-flow). DO NOT OVERINFLATE.
- Patients with a retro-aortic rim of less than 5 mm in any echocardiographic plane, or patients in whom the device physically impinges on (i.e. indents or distorts) the aortic root, may be at increased risk of erosion.
- Do not select a device size greater than 1.5 times the echocardiographic-derived ASD diameter prior to balloon sizing.
- The use of this device has not been studied in patients with patent foramen ovale.
- Use standard interventional cardiac catheteriza- tion techniques to place this device.
- Placement of the AMPLATZERTM Septal Occluder may impact future cardiac interventions, for ex- ample transeptal puncture and mitral valve repair.
- This device contains nickel-titanium alloy, which is generally considered safe. However, in vitro testing has demonstrated that nickel is released from this device for a minimum of 60 days. Patients who are allergic to nickel may have an allergic reaction to this device, especially those with a history of metal allergies. Certain allergic reactions can be serious; patients should be instructed to seek medical assistance immediately if they suspect they are experiencing an allergic reaction. Symptoms may include difficulty in breathing or swelling of the face or throat. While data is currently limited, it is possible that some patients may develop an allergy to nickel if this device is implanted.
- MR Conditional to 3.0 Tesla
Caution should be used if an MRI is performed with a magnetic field of >3.0 tesla. Through non-clinical testing, the AMPLATZERTM device has been known to be MR Conditional at field strengths of 3.0 tesla or less with a maximum whole-body-averaged specific absorption rate (SAR) of 3.83 W/kg at 1.5 tesla and 5.57 W/kg at 5.0 tesla for a 20-minute exposure to a B1 of 118 μT. The AMPLATZERTM device should not migrate in this MR environment. Non-clinical testing has not been performed to rule out the possibility of migration at field strengths higher than 3.0 tesla. In this testing, the device produced a temperature rise of 1.1°C at 1.5 tesla and 1.6°C at 5.0 tesla. MR image quality may be compromised if the area of interest is in the exact same area or relatively close to the position of the device.
POTENTIAL ADVERSE EVENTS
Potential adverse events may occur during or after a procedure placing this device may include, but are not limited to:
Air embolus; Allergic dye reaction; Anesthesia reactions; Apnea; Arrhythmia; Cardiac tamponade; Death; Embolization; Fever Hypertension/ hypotension; Infection including endocarditis; Need for surgery; Pericardial effusion; Perforation of vessel or myocardium; Pseudoaneurysm including blood loss requiring transfusion; Stroke; Tissue erosion; Thrombus formation on discs; Valvular regurgitation