Contemporary ASD Occluders: Comparative Insights on Each Device

Transcatheter closure has become the primary therapeutic approach for ostium secundum atrial septal defects (ASDs), with multiple contemporary devices demonstrating high procedural success.This review presents a comprehensive comparison of current ASD occluders and evidence-based considerations for device selection.We conducted a narrative review of contemporary ASD occluders, analyzing device design characteristics, clinical performance, and safety profiles of major currently used devices, including the Amplatzer Septal Occluder (ASO), GORE CARDIOFORM ASD Occluder (GCA), Occlutech Figulla Flex II, and Cera Septal Occluder.Clinical outcomes, complication rates, and device-specific anatomical considerations were synthesized to inform clinical practice.Contemporary ASD occluders share nitinol-based, self-expanding, double-disc structures but differ in material composition and additional structural elements.The ASO incorporates a 4-mm connecting waist with polyester patches and offers a broad size range (4-40 mm).The GCA uses an expanded polytetrafluoroethylene covering that enhances conformability.The Occlutech device features a hubless design with an optimized braiding pattern, while the Cera device applies a bioceramic titanium nitride coating to reduce nickel release.Device selection criteria include defect size limitations (GCA: effective range 8-35 mm, with reduced suitability above 17 mm), rim adequacy requirements (GCA specifies no minimum retro-aortic rim, whereas other devices generally require > 5 mm), and considerations for complex anatomy, such as the ASO's suitability for multifenestrated defects.Optimal device selection requires individualized assessment of defect size, rim adequacy, anatomical configuration, and operator experience.The expanding capabilities of modern devices continue to broaden the indications for transcatheter closure and further reduce the need for surgical repair in complex anatomies.