Total Endoscopic Removal of Patent Foramen Ovale and Atrial Septal Defect Occluder Devices: A Retrospective Analysis

Background: This study aimed to evaluate the safety and efficacy of total endoscopic removal of patent foramen ovale (PFO) or atrial septal defect (ASD) occluder devices in managing nickel hypersensitivity complications. Methods: A retrospective analysis of 95 patients (2020–2025) undergoing total endoscopic occluder device removal via femoral cardiopulmonary bypass was performed using preoperative nickel allergy screening via patch testing. Outcomes included procedural success, symptom resolution, quality-of-life (QoL) trends, and complications. Results: All devices were removed successfully without thoracotomy. The median bypass time was 71.2 min; 96.8% of residual defects were directly sutured. Nickel hypersensitivity was confirmed in 89.5% of cases. QoL “good” ratings increased from 7.4% preoperatively to 95.8% at 6 months (p < 0.001). No major complications were observed; however, there were two cases of transient atrial fibrillation (2.1%). The median blood loss was 36.8 mL; no reoperations/mortality were noted. Conclusions: Total endoscopic removal is safe and effective for nickel allergy-related complications, with high symptom resolution and improvement in QoL. Preoperative nickel screening optimizes outcomes, while this minimally invasive approach reduces morbidity, thereby supporting the adoption of this approach for device explantation.