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Mid- to Long-term Results of Surgical Treatment of ASD in Patients over 60 Years Old

  • Jeong, In-Seok (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University) ;
  • Ahn, Byoung-Hee (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University) ;
  • Kim, Soon-Jin (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University) ;
  • Oh, Sang-Gi (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University) ;
  • Oh, Bong-Suk (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University) ;
  • Kim, Sang-Hyung (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University)
  • Received : 2010.09.07
  • Accepted : 2010.11.15
  • Published : 2011.04.05

Abstract

Background: There is controversy about the benefit of surgical correction of an atrial septal defect (ASD) in patients over 60 years old. The purpose of this study was to determine whether surgical treatment is beneficial in those 60 years of age or older. Materials and Methods: We reviewed the clinical course of 57 patients (mean age: $63.54{\pm}5.59$ years) diagnosed with an isolated secundum ASD after the age of 60. The 24 patients (group A) who underwent surgical repair were compared with the 33 patients (group B) who were treated non-surgically. The mean follow-up period was $6.8{\pm}4.5$ years. Results: One operative death, 5 late deaths (20.8%) in group A, and 9 deaths (27.3%) in group B occurred in the study period. Symptomatic improvement was noted in 18 patients (75%) of group A after surgery. However 13 patients (39.4%) of group B showed symptomatic improvement during the follow-up period (p=0.012). The incidence of new atrial arrhythmia of the two groups was significantly different (16.7% vs 36.7%, p=0.038). The actuarial 10 year survival rate was 79% in group A and 73% in group B. Conclusion: Although surgical correction of ASD did not increase survival in patients over 60 years old, the surgical outcomes of ASD showed low operative mortality and resulted in symptomatic improvement in the majority of these patients. This study has shown the benefits of surgical closure of ASD even in advanced age in comparison to medical treatment.

Keywords

References

  1. Dickinson DF, Arnold R, Wilkinson JL. Congenital heart disease among 160480 liveborn children in Liverpool 1960 to 1969. Implications for surgical treatment. Br Heart J 1981;46:55-62. https://doi.org/10.1136/hrt.46.1.55
  2. Shah D, Azhar M, Oakley CM, Cleland JGF, Nihoyannopoulus P. Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study. Br Heart J 1994;71:224-8. https://doi.org/10.1136/hrt.71.3.224
  3. Campbell M, Neill C, Suzman S. The prognosis of atrial septal defect. Br Med J 1957;1:1375-83. https://doi.org/10.1136/bmj.1.5032.1375
  4. Stavros K, Annette G, Manfred O, et al. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 1995;333:469-73. https://doi.org/10.1056/NEJM199508243330801
  5. Ward C. Secundum atrial septal defect: routine surgical treatment is not of proven benefit. Br Heart J 1994;71:219-23. https://doi.org/10.1136/hrt.71.3.219
  6. Brickner ME, Hillis D, Lange RA. Congenital heart disease in adults. Second of two parts. N Engl J Med 2000;242:256-63.
  7. Perloff JK. Surgical closure of atrial septal defects in adults. N Engl J Med 1995;333:513-4. https://doi.org/10.1056/NEJM199508243330809
  8. Murphy JG, Gersh BJ, McGoon MD, et al. Long-term outcome after surgical repair of isolated atrial septal defect: follow-up at 27 to 32 years. N Engl J Med 1990;323:1645-50. https://doi.org/10.1056/NEJM199012133232401
  9. Gatzoulis MA, Redington AN, Somerville J, Shore DF. Should atrial septal defects in adults be closed? Ann Thorac Surg 1996;61:657-9. https://doi.org/10.1016/0003-4975(95)01043-2
  10. Gatzoulis MA, Freeman M, Siu S, Webb G, Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 1999;340:839-46. https://doi.org/10.1056/NEJM199903183401103
  11. Cox JL, Jaquiss DB, Schuessler RB, Boineau JP. Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the maze III procedure. J Thorac Cardiovasc Surg 1995;110:485-95. https://doi.org/10.1016/S0022-5223(95)70245-8
  12. Bonchek LI, Burlingame MW, Worley SJ, Vazales BE, Lundy EF. Cox/maze procedure for atrial septal defect with atrial fibrillation: management strategies. Ann Thorac Surg 1993;55:607-10. https://doi.org/10.1016/0003-4975(93)90262-G
  13. Sandoval N, Velasco VM, Orjuela H, et al. Concomitant mitral valve or atrial septal defect surgery and the modified Cox-maze procedure. Am J Cardiol 1996;77:591-6. https://doi.org/10.1016/S0002-9149(97)89312-5
  14. Khositseth A, Cabalka AK, Sweeney JP, et al. Transcatheter amplatzer device closure of atrial septal defect and patent foramen ovale in patients with presumed paradoxical embolism. Mayo Clin Proc 2004;79:35-41. https://doi.org/10.4065/79.1.35
  15. Braun MU, Fassbender D, Schoen SP, et al. Transcatheter closure of patent foramen ovale in patients with cerebral ischemia. J Am Coll Cardiol 2002;39:2019-25. https://doi.org/10.1016/S0735-1097(02)01904-6
  16. Onorato E, Pera IG, Melzi G, Rigatelli G. Persistent redundant Eustachian valve interfering with Amplatzer PFO occluder placement: anatomico-clinical and technical implications. Catheter Cardiovasc Interv 2002;55:521-4. https://doi.org/10.1002/ccd.10141

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