INTERVENTIONAL CARDIOLOGY AND SURGERY

Surgical closure of atrial septal defects in adults: effect of age at operation on outcome

S Ghosh, S Chatterjee, E Black, R K Firmin

Department of Cardiothoracic Surgery, University Hospitals Leicester NHS Trust, Glenfield Hospital, Leicester, UK

Correspondence to:
Correspondence to:
Dr S Ghosh, Department of Cardiothoracic Surgery, University Hospitals Leicester NHS Trust, Glenfield Hospital, Leicester LE3 9QP, UK;
sudip.ghosh{at}uhl-tr.nhs.uk

Objective: To determine whether age has an effect on the long term outcome after surgical closure of atrial septal defects in patients aged 35 years and over.

Methods: Retrospective analysis of 89 patients (64 women) operated on between 1989 and 1999. Patients were divided into two age groups: group I (aged 35–50 years, n = 51) and group II (> 50 years, n = 38). Follow up was between 1–11 years.

Results: One operative death and two late deaths occurred in the study period (both in group II). Preoperatively, 29 (57%) patients were in New York Heart Association functional class III–IV in group I compared with 22 (58%) patients in group II (NS). After operation, 44 (86.2%) patients in group I were found to be in class I–II compared with 25 (71.5%, p < 0.05) in group II. Group I patients had a lower incidence of preoperative atrial fibrillation than those in group II (12 (23.5%) v 17 (43.6%), p < 0.05) and only four (7.8%) patients in group I were in atrial fibrillation requiring long term warfarin after surgery compared with 12 (34%, p < 0.05) in group II. Furthermore, echocardiography showed a greater reduction in right ventricular dimension in group I patients (mean (SD) 4.26 (0.82) v 2.71 (0.41) cm, p < 0.001) than in group II patients (4.36 (0.43) v 3.87 (0.29) cm, p = 0.21). No residual intracardiac shunts were identified during follow up.

Conclusions: Surgical closure of atrial septal defects in adult patients can improve clinical status and prevent right ventricular dilatation. The greatest benefit is seen in younger patients.

Keywords: atrial septal defect; long term outcome; surgical closure; age at operation

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Schreiber, C., Horer, J., Vogt, M., Kuhn, A., Libera, P., Lange, R., Anderson, R. H. (2007). The surgical anatomy and treatment of interatrial communications. MMCTS 2007: 2386- [Abstract] [Full Text]  
• Santoro, G, Pascotto, M, Caputo, S, Cerrato, F, Cappelli Bigazzi, M, Palladino, M T, Iacono, C, Carrozza, M, Russo, M G, Calabro, R (2006). Similar cardiac remodelling after transcatheter atrial septal defect closure in children and young adults. Heart 92: 958-962 [Abstract] [Full Text]  
• Vida, V. L., Barnoya, J., O'Connell, M., Leon-Wyss, J., Larrazabal, L. A., Castaneda, A. R. (2006). Surgical Versus Percutaneous Occlusion of Ostium Secundum Atrial Septal Defects: Results and Cost-Effective Considerations in a Low-Income Country. J Am Coll Cardiol 47: 326-331 [Abstract] [Full Text]