Cause‐Specific Mortality of Patients With Atrial Septal Defect and Up to 50 Years of Follow‐Up

Muroke, Valtteri; Jalanko, Mikko; Haukka, Jari; Sinisalo, Juha

doi:10.1161/jaha.122.027635

Cited by 5 publications

(8 citation statements)

References 26 publications

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“…2,14 Furthermore, in patients with ASD, undergoing ASD closure has been associated with a lower incidence of AF, stroke, and mortality compared with cases where closure was not performed. 13 Some studies have reported no difference in cardiovascular outcomes among patients with ASD irrespective of intervention. 8,9,15 However, other studies have reported superior outcomes in the intervention group compared with the surgical group in terms of complications including stroke and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…2,8,9 Even after ASD closure, the prevalence of various cardiovascular complications was higher in individuals with ASD than in the general population. 10,13 However, in cases where symptoms are present or there is progression in right ventricular remodeling or an increase in pulmonary arterial pressure, early ASD closure is recommended. 2,14 Furthermore, in patients with ASD, undergoing ASD closure has been associated with a lower incidence of AF, stroke, and mortality compared with cases where closure was not performed.…”

Section: Discussionmentioning

confidence: 99%

“…8,9,15 However, other studies have reported superior outcomes in the intervention group compared with the surgical group in terms of complications including stroke and mortality. 11,13,16,17…”

Section: Discussionmentioning

confidence: 99%

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Cardiovascular outcomes in adult patients with atrial septal defect: a nationwide population-based study

Lee,

Park,

Jung

et al. 2024

Preprint

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BackgroundThe beneficial effects of atrial septal defect (ASD) closure on cardiovascular events and mortality in adults remain undetermined. Therefore, this study aimed to investigate the long-term effects of different ASD closure methods on cardiovascular events in adults.MethodsA retrospective analysis was conducted using data obtained from the Korean National Health Insurance Service from 2002 to 2020, focusing on patients aged ≥20 years diagnosed with ASD based on the codes provided by the Tenth revision of International Classification of Diseases codes between 2004 and 2015. Participants were categorized into the observation, device closure, and surgery groups. Propensity score matching (PSM) of variables such as sex, age, comorbidities, and medications was employed at a 2:1:1 ratio to mitigate imbalances among the groups. The Cox proportional hazards model was utilized to compare the occurrence of major adverse cardiovascular events (MACE), including stroke, myocardial infarction (MI), coronary revascularization, and all-cause death, and each individual component among the three groups.ResultsIn total, 20,643 patients with ASD were included in this study. After PSM, there were 6,636 in the observation group and 3,318 each in the device closure and surgery group. Over a 5-year follow-up period, the adjusted hazard ratios for MACE were significantly lower in the surgery (0.72; 95% CI: 0.66–0.79) and device closure groups (0.85; 95% CI: 0.78–0.92) than in the observation group. Beneficial effects on stroke and all-cause mortality were observed in both intervention groups. Additionally, a beneficial effect on coronary revascularization was observed in the surgery group, whereas the impact on MI was not significantly different between the groups.ConclusionsASD closure, whether by surgery or using a device, is associated with a decreased incidence of cardiovascular outcomes in adults. The benefits on cardiovascular outcomes vary with the type of closure method, underscoring the need for a tailored approach to manage ASD in adults.Clinical PerspectivesWhat is new?Compared with no intervention, surgery exhibited a more beneficial effect in terms of MACE, followed by device closure.Device closure appears to be more beneficial in terms of all-cause death.Surgery reduced the occurrence of coronary revascularization.What are the clinical implications?Cardiovascular preventive effects after ASD closure (through surgery or device) were observed in adult patients with ASD when compared to the untreated individuals.The benefits on cardiovascular outcomes vary with the type of closure method, underscoring the need for a tailored approach to manage ASD in adults.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiovascular outcomes in adult patients with atrial septal defect: a nationwide population-based study

Lee,

Park,

Jung

et al. 2024

Preprint

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“…In the previous study, we found that ASD patients had an increased risk for ischemic heart disease mortality [ 13 ]. In line with that finding, we demonstrated an increased risk of new-onset ischemic heart disease during the follow-up in the current (RR 1.73).…”

Section: Discussionmentioning

confidence: 99%

Outcome of transcatheter atrial septal defect closure in a nationwide cohort

et al. 2023

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Background Transcatheter (TC) atrial septal defect (ASD) closure has been the mainstay of therapy for secundum-type ASDs for over 20 years. Aims This nationwide cohort evaluated the long-term outcome of transcatheter-closed ASDs. Methods The study enrolled every transcatheter ASD closure performed in Finland from 1999 to 2019. Five age, sex, and municipality-matched controls per ASD patient were gathered from the general population. The median follow-up period was 5.9 years (range 0–20.8). We used the hospital discharge register to gather all hospital visits and diagnoses. Closure complications and echocardiographic changes were collected from the electronic health records. Results Transcatheter ASD closure was performed in 1000 patients (68.5% females) during the study period. The median (range) age at the time of the procedure was 37.9 (1.8–87.5) years. ASD patients had an increased risk for new-onset atrial fibrillation (RR 2.45, 95% CI: 1.84–3.25), migraine (RR 3.61, 95% CI: 2.54–5.14), ischemic heart disease (RR 1.73, 95% CI: 1.23–2.45), ventricular fibrillation/tachycardia (RR 3.54 (95% CI: 1.48–8.43) and AV conduction disorder (RR 3.60, 95% CI: 1.94–6.70) compared to the control cohort. Stroke risk was not increased (RR 1.36, 95% CI: 0.91–2.03). Adverse events occurred in 6.3% ( n = 63) of the patients, including four erosions and ten device embolizations. Conclusion After TC closure of ASD, patients had a higher risk of new-onset atrial fibrillation and migraine than controls without ASD . As novel findings, we found an increased risk for ischemic heart disease, AV conduction disorders, and ventricular fibrillation/tachycardia. Key messages Even though patients have an excellent overall prognosis after percutaneous ASD closure, the increased incidence of major comorbidities like atrial fibrillation and heart failure prompts more thorough lifelong follow-up. This study’s novel findings revealed the increased risk for ischemic heart disease, AV conduction disorders, or ventricular tachycardia/fibrillation during the follow-up. Major complications after the closure are rare; erosion is seen in 0.4% of the patients and embolization in 1.0% of the patients.

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“…Significant shunts trigger a cascade of pathological alterations in cardiac chambers and pulmonary vasculature, including an increased in the right atrial pressure, right‐sided enlargement, and pulmonary hyperperfusion, which may lead to damage to the right atrial reservoir, pulmonary vascular remodeling, and elevated pulmonary vascular resistance (PVR), ultimately resulting in heart failure and pulmonary arterial hypertension (PAH) in larger and untreated ASD 107,108 . Compared with general community, patients with ASD have a higher overall mortality due to congenital malformations, stroke, heart disease, other diseases of the circulatory, and disease of the endocrine and respiratory systems, even after ASD closure 109 …”

Section: Atrial Septal Defectmentioning

confidence: 99%

Congenital heart disease: types, pathophysiology, diagnosis, and treatment options

Meng,

Song,

Zhang

et al. 2024

MedComm

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Congenital heart disease (CHD) is a structural abnormality of the heart and/or great vessels and patients with CHD are at an increased risks of various morbidities throughout their lives and reduced long‐term survival. Eventually, CHD may result in various complications including heart failure, arrhythmias, stroke, pneumonia, and sudden death. Unfortunately, the exact etiology and pathophysiology of some CHD remain unclear. Although the quality of life and prognosis of patients with CHD have significantly improved following technological advancement, the influence of CHD is lifelong, especially in patients with complicated CHD. Thus, the management of CHD remains a challenge due to its high prevalence. Finally, there are some disagreements on CHD among international guidelines. In this review, we provide an update of the pathophysiology, diagnosis, and treatment in most common type of CHD, including patent foramen ovale, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, coarctation of the aorta, transposition of the great arteries, congenitally corrected transposition of the great arteries, coronary anomalies, left and right ventricular outflow tract obstruction, tetralogy of Fallot and Ebstein anomaly. In particular, we focus on what is known and what is unknown in these areas, aiming to improve the current understanding of various types of CHD.

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Cause‐Specific Mortality of Patients With Atrial Septal Defect and Up to 50 Years of Follow‐Up

Cited by 5 publications

References 26 publications

Cardiovascular outcomes in adult patients with atrial septal defect: a nationwide population-based study

Cardiovascular outcomes in adult patients with atrial septal defect: a nationwide population-based study

Outcome of transcatheter atrial septal defect closure in a nationwide cohort

Congenital heart disease: types, pathophysiology, diagnosis, and treatment options

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