Risk Analysis of the Long-Term Outcomes of the Surgical Closure of Secundum Atrial Septal Defects
Key result
Preoperative tricuspid regurgitation is linked to ~95% higher late mortality after surgical ASD closure.
- HR 1.95
- 95% CI 1.09 to 3.16
- P=0.023
- n=693
Why the study?
Does concomitant tricuspid annuloplasty improve long-term survival in adults undergoing surgical closure of secundum atrial septal defects with significant preoperative tricuspid regurgitation?
Population
693 adults with secundum atrial septal defect, mean age 40.9±13.1 years, 28.7% male. Excluded patients with…
Comparison
Surgical closure of secundum ASD, with or… vs For the overall cohort, none. For the subgroup…
Design
Cohort
Follow-up
mean 12.4±4.7 years
Authors
Discussion
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Member takes
Implication
Preoperative TR identifies higher late-mortality risk after ASD closure; observational data leave open whether concomitant repair improves survival.
Study Design
Type
Cohort (n=693)
Multicenter
No
Structured PICO
Does concomitant tricuspid annuloplasty improve long-term survival in adults undergoing surgical closure of secundum atrial septal defects with significant preoperative tricuspid regurgitation?
P
Population
693 adults with secundum atrial septal defect who underwent surgical closure, followed for a mean of 12.4 years.
E
Exposure
Surgical closure of secundum ASD (63.3% via sternotomy, 36.7% via thoracotomy), with or without concomitant procedures such as tricuspid annuloplasty (TAP) or the maze procedure.
C
Comparator
For the overall cohort, none (observational). For the subgroup with significant preoperative tricuspid regurgitation (TR), surgical ASD closure with tricuspid annuloplasty (TAP, n=107) was compared to surgical ASD closure without TAP (non-TAP, n=30).
O
Outcome
Long-term survival (mortality) and identification of risk factors for late mortality.hard clinical
Main Result
Hazard Ratio: 1.95 (95% CI 1.09–3.16)
p-value: p=0.023
Surgical closure of secundum ASD is safe with excellent long-term survival, though significant preoperative tricuspid regurgitation and older age independently predict late mortality, suggesting early intervention before TR development may be beneficial.
Limitations
- Retrospective nature of the analysis
- Data limited to a single high-volume tertiary academic center, limiting generalizability
- Detailed information regarding specific causes of mortality was not available from the registry
- Differences in baseline characteristics between the tricuspid annuloplasty and non-annuloplasty groups
- Unable to show a direct causal relationship between tricuspid regurgitation and death
- Data limited to a single high-volume tertiary academic center (may not be generalizable)
- Lack of specific cause of death data from the national registry
- Baseline differences between TAP and non-TAP groups (e.g., age and TR severity) may confound survival analysis
Cite This Study
Kim et al. (2017) conducted a cohort in Secundum atrial septal defect (n=693). Significant preoperative tricuspid regurgitation vs. Non-significant tricuspid regurgitation was evaluated on Late mortality (HR 1.95, 95% CI 1.09 to 3.16, p=0.023). Significant preoperative tricuspid regurgitation was an independent risk factor for late mortality (HR 1.95) following surgical closure of secundum atrial septal defects, and concomitant tricuspid repair did not improve long-term survival.