Long-term mortality in patients with atrial septal defect: a nationwide cohort-study

Nyboe, Camilla; Karunanithi, Zarmiga; Nielsen‐Kudsk, Jens Erik; Hjortdal, Vibeke E.

doi:10.1093/eurheartj/ehx687

Cited by 84 publications

(84 citation statements)

References 25 publications

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“…We submit, however, that the excellent outcome reported herewith largely reflects our proactive approach of offering ASD closure mainly for prognostic reasons before cardiac decompensation and overt symptoms ensue. This contrasts to historical studies of pioneering era of cardiac surgery7 and reports of registries span over a long period of intervention with a different and more ‘reactive’ approach and also longer periods of follow-up, both relevant to the different outcomes reported in these studies, compared with the present study 15. We have clearly come a long way in ASD closure.…”

Section: Discussioncontrasting

confidence: 90%

“…While overall reduction in morbidity and consequently improvement in quality of life has been shown after closure of ASD irrespective of age,19–21 life expectancy of patients with ASD closure in adulthood is nevertheless considered to be impaired when compared with healthy controls 15. Our contemporary data show that a proactive ASD closure approach in adulthood is associated with normal survival compared with that expected in the general population matched for gender and age in the mid to longer term follow-up.…”

Section: Discussionmentioning

confidence: 58%

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Atrial septal defect closure in adulthood is associated with normal survival in the mid to longer term

Brida

Diller

Kempny

et al. 2019

Heart

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ObjectiveThe prognostic benefit of atrial septal defect (ASD) closure in adulthood, particularly in advanced age, remains uncertain. The aim of our study was to examine the impact of ASD closure in a contemporary adult cohort on mid to longer term survival as compared with expected survival in the general population.MethodsWe study herewith all consecutive patients (≥16 years of age) who underwent ASD closure, catheter or surgical, at our tertiary centre between 2001 and 2012. Furthermore, we compare survival of our ASD closure cohort with expected survival in age and gender-matched general population and standardised mortality ratios (SMR) were calculated.ResultsA total of 608 patients (mean age 45.4±16.7 years) underwent ASD closure (catheter 433(71.2%), surgical 175(28.8%)). There was no 30-day mortality and periprocedural complications were low (n=40, 6.6%). During a median follow-up of 6.7 (IQR 4.2–9.3) years 16 (2.6%) patients died; survival was similar to the general population (p=0.80) including patients >40 or >60 years of age at ASD closure (p=0.58 and p=0.64, respectively). There was no survival difference between gender (male: SMR 0.93; 95% CI 0.52 to 1.64, p=0.76; female: SMR 0.99; 95% CI 0.58 to 1.66, p=0.95) or mode of closure compared with general population (catheter: SMR 1.03; 95% CI 0.68 to 1.55, p=0.89; surgical: SMR 0.65; 95% CI 0.22 to 1.88, p=0.38).ConclusionPerioperative mortality and morbidity in a large contemporary adult cohort undergoing ASD closure, catheter or surgical, is extremely low. Mid to longer term survival is excellent irrespective of age, gender and mode of closure, and similar to matched general population.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 58%

Atrial septal defect closure in adulthood is associated with normal survival in the mid to longer term

Brida

Diller

Kempny

et al. 2019

Heart

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“…Patients with small, unrepaired ASD were once believed to be as healthy as the general population; however, this notion has been called into question. We have demonstrated that patients with a small, unrepaired ASD that persists into adult life have increased risk of premature death (mean age of death was 63 years), more chronic diseases, worse functional capacity, higher levels of stress, and lower scores on self‐assessed physical function compared to the general population …”

Section: Introductionmentioning

confidence: 99%

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Udholm

Nyboe

Jørgensen

et al. 2019

Congenital Heart Disease

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Objective For the first time, we wish to assess the psychiatric burden in adult patients living with small, unrepaired atrial septal defects (ASD) using register‐based data, combined with self‐reported measures on levels emotional distress and educational status. Design A descriptive study using both the unique Danish registries and validated psychiatric questionnaires and scales, including: The Symptom Checklist, Whiteley‐7, and Brief Illness Perception Questionnaire. Patients Adult patients with small, unrepaired ASD, diagnosed between 1953 and 2011. Outcome Measures Number of register‐based psychiatric diagnoses. Additionally, symptoms of anxiety, depression, somatization, health anxiety, illness perception, and levels of educational attainment compared to age‐ and gender‐matched individuals from the reference group. Results We identified 723 Danish patients with a small, unrepaired ASD. Approximately 17% of the patients eligible for inclusion had one or more psychiatric diagnoses. The most common diagnoses were neurotic, stress‐related, and somatoform disorders. A total of 140 patients (mean age 33 years) was included for examination of their mental health using psychiatric questionnaires and scales. Patients with small ASD had higher scores of depression and anxiety when compared to the reference group (0.57 ± 0.67 vs 0.39 ± 0.52; P < .001). Furthermore, patients reported more symptoms of somatization (0.51 ± 0.48 vs 0.34 ± 0.39; P < .001). Finally, a higher percentage of patients with an unrepaired ASD had no education beyond high school when compared to the reference group (33.3% vs 14.3%; P < .001) and a smaller proportion of patients had completed a short‐cycle higher education (6.5% vs 16.1%; P = .002). Conclusion Patients with a small, unrepaired ASD in adult life have more symptoms of anxiety, depression, and somatization compared to the reference group. Furthermore, fewer patients had no education beyond high school. These results support the guidelines that adults with small ASD warrants regular lifelong follow‐up in specialized clinics aware of not only adverse somatic outcome but also rates of depression and anxiety.

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“…8 Evidence clearly suggested that untreated large secundum defects are associated with a reduced lifespan. 8 Evidence clearly suggested that untreated large secundum defects are associated with a reduced lifespan.…”

Section: Discussionmentioning

confidence: 99%

Strategy of treating secundum atrial septal defect not referred to percutaneous closure

Zhang¹,

Yang

et al. 2019

Congenital Heart Disease

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Objective: To evaluate safety and effectiveness of intraoperative device closure for secundum atrial septal defect (ASD) not referred to percutaneous closure. Design and Patients:From April 2010 to December 2018, 231 secundum ASD children (≤14 years) directly recommended to surgical repair were enrolled in this study.These patients were divided into two groups according to the parents' choice based on surgeons' recommendation. Follow-up evaluations were adopted at 2 weeks, 3 months, 6 months, and 12 months after the procedure and yearly thereafter. In Group A, 127 patients underwent an initial attempt at device closure. In Group B, 104 patients underwent a repair procedure under cardiopulmonary bypass. Results: All patients survived. Group A had lower values of operation time, mechanical ventilation time, cardiac intensive care unit duration and amount of blood transfusion. Nevertheless, postoperative hospitalization time between two groups showed no statistical difference. In group A, 109 (85.83%) patients were successfully occluded, whereas 18 (14.17%) patients were converted to open-heart surgery. No severe complications occurred in the follow-up period.Conclusion: Intraoperative device closure is safe, effective procedure for selected cases with secundum ASDs which were not referred to percutaneous closure because of more suitable occluder selection, no "unbutton effect" and stitching enhancement. K E Y W O R D Schildren, intraoperative device closure, percutaneous closure, secundum ASD

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Long-term mortality in patients with atrial septal defect: a nationwide cohort-study

Cited by 84 publications

References 25 publications

Atrial septal defect closure in adulthood is associated with normal survival in the mid to longer term

Atrial septal defect closure in adulthood is associated with normal survival in the mid to longer term

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Strategy of treating secundum atrial septal defect not referred to percutaneous closure

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