Transcatheter closure of atrial septal defects with the STARFlex device: Early results and follow-up

Mario Carminati, Massimo Chessa, Gianfranco Butera, Roberta M. Bini, Sandra Giusti, Pierluigi Festa, Isabella Spadoni, Sofia Redaelli, Gerd Hausdorf

Research output: Contribution to journalArticlepeer-review


Background: The STARFlex (SF) device is a CardioSEAL (CS) double-umbrella device that has been modified by the addition of a self-centering mechanism comprised of nitinol springs connected between the two umbrellas and a flexible core wire with a pin-pivoting connection. This paper compares the results of atrial septal defect (ASD) closure with CardioSEAL and STARFlex devices. Patients and Methods: Between December 1996 and March 2000, 117 patients underwent ASD closure with CardioSEAL (n = 79) and STARFlex (n = 38). The mean age (17 years), weight (49 kg), and ASD size (15 mm) were similar in the two groups. The procedures were performed under general anesthesia with both fluoroscopic and transesophageal echocardiographic monitoring. Immediate Results: The devices were successfully implanted in all patients. Ten patients had multiple ASDs. A single device was used in four patients (CardioSEAL in three, STARFlex in one), while a simultaneous placement of two CardioSEAL (one patient) or two STARFlex (five patients) were performed in six patients. The results are summarized as follows: CS SF, Flouroscopy time (min) 21/(6-66) 17 (5-73), Residual shunt (after catherization) 38/79 (48%) 11/38 (29%), Residual shunt (at discharge) 18/75 (24%) 5/38 (13%), Device embolizaton/malposition* 4/79 (5%) 1/38 (3%), *Four patients underwent elective surgical repair, in 1 patient the embolized device was retrieved by catheter, and antoehr device successfully implanted. Follow-Up Results: On follow-up clinical exam, electrocardiograms, chest X-rays, and echocardiograms were obtained at 1, 6, and 12 months. CS SF, Residual shunt (1 month) 12/74 (16%) 3/25 (12%), Residual shunt (6 months) 11/69 (16%) 0/14 (0%), Residual shunt (12 months) 9/63 (14%) 0/7 (0%), Arm fractures 4/79 (19%) 1/38 (3%), During follow-up there were no deaths, endocarditis, rhythm disturbances, or other complications. Arm fractures were observed almost exclusively with large CardioSEAL devices (40 mm, less frequently with 33 mm), and only in one 33-mm STARFlex device. There were no clinical complications related to fractures. Conclusions: The STARFlex device seems to offer better results than the CardioSEAL, with significantly lower rates of residual shunts and arm fractures.

Original languageEnglish
Pages (from-to)319-324
Number of pages6
JournalJournal of Interventional Cardiology
Issue number3
Publication statusPublished - 2001

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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