Intracardiac vs. transesophageal echocardiography guided transcatheter closure of patent foramen ovale and atrial septal defects
Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who u...
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| Vydáno v: | Cardiovascular revascularization medicine Ročník 77; s. 61 - 65 |
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01.08.2025
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| Abstract | Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who underwent transcatheter ASD/PFO closure between 2016 and 2020 using ICE or TEE in the Nationwide Readmissions Database (NRD) were identified. Propensity-score matching was performed to compare in-hospital adverse events, length of stay (LOS), cost, and 30-day non-elective readmissions. A total of 964 patients underwent ASD/PFO closure with ICE (38.3 %, n = 369) or TEE (61.7 %, n = 595) between 2016 and 2020. Propensity score matching yielded 327 patients in each group, which were well balanced. Median (IQR) age was 59.0 (46.0, 72.0) years and 54.7 % were female. No difference was observed in the rate of in-hospital major adverse events between groups. ICE guidance was associated with a lower median cost (ICE $20,140.1 (14,622.3, 25,027.0) vs TEE $20,740.4 (14,137.5, 33,045.3), p < 0.04). In conclusion, ICE guided ASD/PFO closure was associated with lower hospitalization cost without increasing in-hospital adverse events when compared with TEE guidance.
•ICE-guided transcatheter PFO/ASD closures had a safety profile similar to TEE guidance within the context of measured adverse outcomes.•Both ICE and TEE had similarly low rates of in-hospital adverse events, but costs were less with ICE.•These results are reassuring and support the adoption of ICE as a primary imaging modality for transcatheter PFO/ASD closures. |
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| AbstractList | Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who underwent transcatheter ASD/PFO closure between 2016 and 2020 using ICE or TEE in the Nationwide Readmissions Database (NRD) were identified. Propensity-score matching was performed to compare in-hospital adverse events, length of stay (LOS), cost, and 30-day non-elective readmissions. A total of 964 patients underwent ASD/PFO closure with ICE (38.3 %, n = 369) or TEE (61.7 %, n = 595) between 2016 and 2020. Propensity score matching yielded 327 patients in each group, which were well balanced. Median (IQR) age was 59.0 (46.0, 72.0) years and 54.7 % were female. No difference was observed in the rate of in-hospital major adverse events between groups. ICE guidance was associated with a lower median cost (ICE $20,140.1 (14,622.3, 25,027.0) vs TEE $20,740.4 (14,137.5, 33,045.3), p < 0.04). In conclusion, ICE guided ASD/PFO closure was associated with lower hospitalization cost without increasing in-hospital adverse events when compared with TEE guidance.
•ICE-guided transcatheter PFO/ASD closures had a safety profile similar to TEE guidance within the context of measured adverse outcomes.•Both ICE and TEE had similarly low rates of in-hospital adverse events, but costs were less with ICE.•These results are reassuring and support the adoption of ICE as a primary imaging modality for transcatheter PFO/ASD closures. Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who underwent transcatheter ASD/PFO closure between 2016 and 2020 using ICE or TEE in the Nationwide Readmissions Database (NRD) were identified. Propensity-score matching was performed to compare in-hospital adverse events, length of stay (LOS), cost, and 30-day non-elective readmissions. A total of 964 patients underwent ASD/PFO closure with ICE (38.3 %, n = 369) or TEE (61.7 %, n = 595) between 2016 and 2020. Propensity score matching yielded 327 patients in each group, which were well balanced. Median (IQR) age was 59.0 (46.0, 72.0) years and 54.7 % were female. No difference was observed in the rate of in-hospital major adverse events between groups. ICE guidance was associated with a lower median cost (ICE $20,140.1 (14,622.3, 25,027.0) vs TEE $20,740.4 (14,137.5, 33,045.3), p < 0.04). In conclusion, ICE guided ASD/PFO closure was associated with lower hospitalization cost without increasing in-hospital adverse events when compared with TEE guidance.Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who underwent transcatheter ASD/PFO closure between 2016 and 2020 using ICE or TEE in the Nationwide Readmissions Database (NRD) were identified. Propensity-score matching was performed to compare in-hospital adverse events, length of stay (LOS), cost, and 30-day non-elective readmissions. A total of 964 patients underwent ASD/PFO closure with ICE (38.3 %, n = 369) or TEE (61.7 %, n = 595) between 2016 and 2020. Propensity score matching yielded 327 patients in each group, which were well balanced. Median (IQR) age was 59.0 (46.0, 72.0) years and 54.7 % were female. No difference was observed in the rate of in-hospital major adverse events between groups. ICE guidance was associated with a lower median cost (ICE $20,140.1 (14,622.3, 25,027.0) vs TEE $20,740.4 (14,137.5, 33,045.3), p < 0.04). In conclusion, ICE guided ASD/PFO closure was associated with lower hospitalization cost without increasing in-hospital adverse events when compared with TEE guidance. AbstractTranscatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who underwent transcatheter ASD/PFO closure between 2016 and 2020 using ICE or TEE in the Nationwide Readmissions Database (NRD) were identified. Propensity-score matching was performed to compare in-hospital adverse events, length of stay (LOS), cost, and 30-day non-elective readmissions. A total of 964 patients underwent ASD/PFO closure with ICE (38.3 %, n = 369) or TEE (61.7 %, n = 595) between 2016 and 2020. Propensity score matching yielded 327 patients in each group, which were well balanced. Median (IQR) age was 59.0 (46.0, 72.0) years and 54.7 % were female. No difference was observed in the rate of in-hospital major adverse events between groups. ICE guidance was associated with a lower median cost (ICE $20,140.1 (14,622.3, 25,027.0) vs TEE $20,740.4 (14,137.5, 33,045.3), p < 0.04). In conclusion, ICE guided ASD/PFO closure was associated with lower hospitalization cost without increasing in-hospital adverse events when compared with TEE guidance. Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who underwent transcatheter ASD/PFO closure between 2016 and 2020 using ICE or TEE in the Nationwide Readmissions Database (NRD) were identified. Propensity-score matching was performed to compare in-hospital adverse events, length of stay (LOS), cost, and 30-day non-elective readmissions. A total of 964 patients underwent ASD/PFO closure with ICE (38.3 %, n = 369) or TEE (61.7 %, n = 595) between 2016 and 2020. Propensity score matching yielded 327 patients in each group, which were well balanced. Median (IQR) age was 59.0 (46.0, 72.0) years and 54.7 % were female. No difference was observed in the rate of in-hospital major adverse events between groups. ICE guidance was associated with a lower median cost (ICE $20,140.1 (14,622.3, 25,027.0) vs TEE $20,740.4 (14,137.5, 33,045.3), p < 0.04). In conclusion, ICE guided ASD/PFO closure was associated with lower hospitalization cost without increasing in-hospital adverse events when compared with TEE guidance. |
| Author | Shatla, Islam Huded, Chetan P. Huber, Kenneth Christopher Lehenbauer, Kyle Kennedy, Kevin Magalski, Anthony Saxon, John Thomas Chhatriwalla, Adnan K. Abdelkarim, Islam |
| Author_xml | – sequence: 1 givenname: Islam surname: Shatla fullname: Shatla, Islam email: ishatla@kumc.edu organization: Department of Internal Medicine, Kansas University Medical Center, Kansas City, KS, USA – sequence: 2 givenname: Kevin surname: Kennedy fullname: Kennedy, Kevin organization: Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA – sequence: 3 givenname: John Thomas surname: Saxon fullname: Saxon, John Thomas organization: Division of Cardiovascular Disease, University of Virginia Health System, Charlottesville, VA, USA – sequence: 4 givenname: Adnan K. surname: Chhatriwalla fullname: Chhatriwalla, Adnan K. organization: Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA – sequence: 5 givenname: Anthony surname: Magalski fullname: Magalski, Anthony organization: Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA – sequence: 6 givenname: Kyle surname: Lehenbauer fullname: Lehenbauer, Kyle organization: Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA – sequence: 7 givenname: Islam surname: Abdelkarim fullname: Abdelkarim, Islam organization: Department of Internal Medicine, Kansas University Medical Center, Kansas City, KS, USA – sequence: 8 givenname: Kenneth Christopher surname: Huber fullname: Huber, Kenneth Christopher organization: Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA – sequence: 9 givenname: Chetan P. surname: Huded fullname: Huded, Chetan P. organization: Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA |
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| Snippet | Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or... AbstractTranscatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or... |
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| SubjectTerms | Aged Atrial septal defect Cardiac Catheterization - adverse effects Cardiac Catheterization - economics Cardiac Catheterization - instrumentation Cardiovascular Cost Savings Cost-Benefit Analysis Databases, Factual Echocardiography, Transesophageal - adverse effects Echocardiography, Transesophageal - economics Female Foramen Ovale, Patent - diagnostic imaging Foramen Ovale, Patent - economics Foramen Ovale, Patent - therapy Heart Septal Defects, Atrial - diagnostic imaging Heart Septal Defects, Atrial - economics Heart Septal Defects, Atrial - therapy Hospital Costs Humans Intracardiac echocardiography Length of Stay Male Middle Aged Patent foramen ovale Patient Readmission Predictive Value of Tests Retrospective Studies Risk Factors Time Factors Transesophageal echocardiography Treatment Outcome Ultrasonography, Interventional - adverse effects Ultrasonography, Interventional - economics United States |
| Title | Intracardiac vs. transesophageal echocardiography guided transcatheter closure of patent foramen ovale and atrial septal defects |
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