Transcatheter closure of ostium secundum atrial septal defect (osASD) is the first-line treatment in most children and adults. However, the use of multiple devices during the same procedure is uncommon, and data on the feasibility and safety of this approach remain limited. This study aims to assess the outcomes of osASD closure using multiple devices.

This prospective, single-center cohort study included patients who underwent transcatheter osASD closure with an Amplatzer Septal Occluder (ASO) between May 1998 and December 2021 at Marie Lannelongue Hospital. Periprocedural data and major adverse events (MAEs) were retrospectively analyzed. A comparison was then made between patients who received a single device versus multiple devices.

Among 2,253 patients, 216 (9.6%) had complex osASD, including 6.4% with double osASD and 3.7% with multi-fenestrated osASD. Multiple devices were implanted in 19 patients (0.8%), including four pediatric cases. One 53-year-old patient was implanted with three devices (ASO sizes 20, 12, and 10mm). Patients with multiple devices were more likely to have an interatrial septal aneurysm (OR 3.54 [1.38−9.06], p=0.008). Procedural success was 100%, with no major adverse events in these patients. No significant differences in minor complications, atrial tachycardia, residual shunt, or pericardial effusion were observed between groups. Long-term follow-up of 6.2 years showed no deaths, cardiac reinterventions, significant residual shunts, thromboembolic events, atrial arrhythmias, or conduction disturbances in the multiple-device group.

Transcatheter closure of complex osASD using multiple devices is a feasible and safe approach, with excellent procedural and long-term outcomes when required.