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Congenital heart disease
Original research article
Atrial septal defect closure in adulthood is associated with normal survival in the mid to longer term
  1. Margarita Brida1,2,3,
  2. Gerhard-Paul Diller1,2,4,
  3. Aleksander Kempny1,
  4. Maria Drakopoulou1,
  5. Darryl Shore1,
  6. Michael A Gatzoulis1,2,
  7. Anselm Uebing1,5
  1. 1 Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
  2. 2 National Heart and Lung Institute, Imperial College London, London, UK
  3. 3 Division of Adult Congenital Heart Disease, Department of Cardiovascular Disease, University Hospital Centre Zagreb, Zagreb, Croatia
  4. 4 Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
  5. 5 Division of Paediatric Cardiology, University Hospital Muenster, Muenster, Germany
  1. Correspondence to Dr Margarita Brida, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London SW3 6NP, UK; margarita.brida{at}icloud.com

Abstract

Objective The 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.

Methods We 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.

Results A 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).

Conclusion Perioperative 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.

  • atrial septal defect
  • survival
  • catheter ASD closure
  • surgical ASD closure

https://doi.org/10.1136/heartjnl-2018-314380

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    Footnotes

    • Contributors AU and GPD planned and conducted the study. MB, AK, MD, DS and MAG made substantial contributions to conception and design, analysis and interpretation of data. MB and MAG made substantial contribution to analysis, drafting the article and revising it critically for important intellectual content. All authors gave final approval of the version to be submitted and any revised version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was approved by the Research and Governance Committee at our institution.

    • Provenance and peer review Not commissioned; externally peer reviewed.