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Here today, gone tomorrow: Percutaneous closure of atrial septal defects utilizing a bioabsorbable device

Percutaneous therapy has evolved to become first-line treatment for patients judged to require closure of secundum atrial septal defects (ASD) [1]. As randomized trials are lacking, predilection for a particular device is dictated primarily by personal preference. Prior comparative series have suggested a somewhat higher frequency of embolization, dislocation, and device thrombosis with a Cardioseal/Starflex device when compared with those of differing designs [2,3]. Partially in an effort to address these perceived deficiencies and others, the BioSTAR biodegradable occluder (NMT Medical, Boston, MA) has been developed. This device incorporates bioresorbable collagen over a wire frame. In this issue of Catheterization and Cardiovascular Interventions, Morgan and colleagues describe an analysis of 10 children undergoing ASD closure with a BioSTAR device, comparing them to a matched cohort undergoing closure with an Amplatzer Septal Occluder (ASO) [4]. Specifically addressing eradication of atrial level shunting, the authors documented complete acute and long-term success in 9 of 10 children treated with a BioSTAR device, while all 10 matched children who had an ASO used were successfully closed. For unclear reasons, the implanting physician more frequently used intracardiac ultrasound guidance in the population receiving the BioSTAR device. In my view, the current report documents a significant step forward in the therapy of patients with atrial level shunts. Although only partially resorbable, the BioSTAR design would likely reduce the risks of rare but potentially life-threatening complications associated with percutaneous ASD closure events, such as device thrombosis and atrial erosion [3,5]. Another potential benefit to a bioresorbable design might include longterm retention of transseptal access, for ablative arrhythmia therapies, such as those targeting atrial fibrillation. Concerns regarding the current device reported on which may limit broad applicability, to a wider population include concerns regarding device efficacy in larger defects, the potential for a greater frequency of procedural complications attendant to the need for 11 French delivery sheaths in a pediatric population and fewer options regarding sizes for BioSTAR when compared with ASO devices. One must also be cognizant of the fact that in the current report, procedural times were longer in the group receiving the BioSTAR device raising the potential for enhanced radiation dose in these patients. In summary, Morgan and colleagues are to be congratulated on a nicely done, thought-provoking study. Where bioabsorbable devices eventually reside in our therapeutic armamentarium will be determined by long-term reports on larger patient populations.