Do patients over 40 years of age benefit from surgical closure of atrial septal defects?

Abstract

Objective-To determine the value of surgical closure of atrial septal defects in patients over 40 years of age. Methods-Retrospective analysis of 76 patients (63 women, 13 men), age range 40-62 years (mean (SD) 45.8 (5.1) years), who underwent surgical repair of atrial septal defect. Pre-and postoperative clinical status (New York Heart Association (NYHA) functional class) was assessed, and ECG, x ray, and echocardiographic investigations performed. Follow up was between 1 and 17 years. Results-One operative and one late death occurred during the study period. Before operation, 47 patients (61.8%) were in NYHA functional classes III and IV. After operation, 61 patients (82.4%) were in classes I and II. Four patients had atrial fibrillation before surgery versus nine after surgery. Before operation, 52 patients had intensified pulmonary vascularity compared with only seven after operation. Echocardiographic examination showed a significant reduction in right ventricular dimension (4.10 (0.91) v 2.95 (0.36) cm, p < 0.001). No residual intracardiac shunts were identified on echocardiographic follow up. Conclusions-Surgical closure of atrial septal defects in patients over 40 years old can improve their clinical status and prevent right ventricular dilatation and insuYciency. (Heart 2001;85:300-303)

Congenital Heart Disease in the Older Adult

“…[346][347][348][349] Recently, there have been an increasing number of reports regarding results after surgical closure among elderly patients (>60 years of age) that demonstrate equivalent survival to younger patients, albeit with slightly higher complication rates. 36,350,351 In a study 36 of 68 patients between 68 and 86 years of age at a single institution undergoing either surgical (n=13) or device (n=54) closure, the incidence of major complications (including pneumothorax, heart failure, and pneumonia) was 23%, higher than that recently reported 352 using the Society of Thoracic Surgeons' Congenital Heart Surgery Database (20%) and in another recent single-institution review 353 (12%). Of note, however, there were no operative deaths among the elderly cohort.…”

Improvement after Surgical Closure of Secundum Atrial Septal Defects in Adults

“…Some authors estimated the mortality in their study, it was 3.3% all of them were in the older age group as well [14]. The mortality was much less with other research studies in young patients [29,30].…”

“…Surgical repair of ostium Secundum or sinus venosus ASD performed early in childhood without significant residual lesions could be considered effective surgery [12]. The closure of an ASD in an adult, even when there is a significant left to right short circuit, may be less than satisfactory, and there is still doubt if these patients will benefit from surgical closure of atrial septal defects [13][14][15].…”

Improvement in Exercise Capacity in Asymptomatic and Mildly Symptomatic Adults After Atrial Septal Defect Percutaneous Closure

“…Jemeliety et al, 17 in a retrospective analysis of 76 patients aged 40 to 62 years at surgery and followed for 6.9 years, found a significant improvement in functional class with 61.8% patients in NYHA III or IV before surgery compared with 82.4% in NYHA I or II after surgery.…”