Closure of secundum atrial septal defects in the adult and elderly patients

Abstract

OBJECTIVES: Treatment of atrial septal defect (ASD) in adults is still controversial, and with older age the likelihood of treatment is decreased. The aim of this study was to investigate the effect of ASD closure in adults and especially in the elderly in our institution in a retrospective review. METHODS: Adult patients (n = 220) underwent surgical or catheter closure for an isolated ASD at Aarhus University Hospital from 1990 to 2008. Eleven were lost to follow-up and 13 had cardiac comorbidity, and thus 196 were eligible for analysis in the study. Hospital records were reviewed and symptoms and echocardiographic findings registered preoperatively and at 3-month follow-up. Patients were divided into Group I (n = 117): between 18 and 50 years old and Group II (n = 79): older than 50 years. Symptoms and echocardiographic findings before and 3 months after closure were compared within and between the two groups. RESULTS: One patient (0.5%) died during follow-up. Complications occurred in 16% in Group I and 22% in Group II. There was an absolute risk reduction of -62 and -52%, respectively in right ventricle (RV) dilation after operation. Atrial fibrillation was noticed preoperatively in 6% of the young and 47% of the elderly, with an absolute risk reduction after treatment of -20% in Group II (P < 0.0001). Subjective symptoms occurred in 75% in Group I and 99% in Group II with a postoperative reduction to 43 and 67%, respectively. In Group I, 70% felt an improvement of symptoms while this was true for 89% in Group II. CONCLUSIONS: Symptoms and RV dilation are more pronounced in the elderly (>50 years), but reversibility is the same as in the young (<50 years) patients. The elderly benefit substantially from ASD closure. Based on these data, ASD closure is recommendable even after the fifth decade. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.