Key result
Atrial septal defect closure in adults resulted in excellent mid to longer term survival (2.6% mortality over a median 6.7 years), which was similar to the matched general population (p=0.80).
Why the study?
The prognostic benefit of atrial septal defect closure in adulthood, particularly in advanced age, remained uncertain.
Does atrial septal defect closure in adulthood result in survival comparable to the general population?
Cohort (n=608)
No
Does atrial septal defect closure in adulthood result in survival comparable to the general population?
p-value: p=0.80
Atrial septal defect closure in adulthood is associated with extremely low perioperative mortality and mid- to long-term survival comparable to the age- and gender-matched general population.
Adult ASD closure was associated with survival matching the general population; leaves open randomized comparison to observation.
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.
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Brida et al. (2019) conducted a cohort in Atrial septal defect (ASD) (n=608). ASD closure (catheter or surgical) vs. Age and gender-matched general population was evaluated on Mid to longer term survival compared with expected survival in the general population (p=0.80). Atrial septal defect closure in adults resulted in excellent mid to longer term survival (2.6% mortality over a median 6.7 years), which was similar to the matched general population (p=0.80).
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