Long-Term (5- to 20-Year) Outcomes After Transcatheter or Surgical Treatment of Hemodynamically Significant Isolated Secundum Atrial Septal Defect

• Published in: The American journal of cardiology 2012-05, Vol.109 (9), p.1348-1352
• Main Authors: Kutty, Shelby, MD, Hazeem, Anas Abu, MBBS, Brown, Kimberly, RN, Danford, Christopher J., BS, Worley, Sarah E., MS, Delaney, Jeffrey W., MD, Danford, David A., MD, Latson, Larry A., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Cardiac arrhythmia; Cardiac Catheterization - methods; Cardiology; Cardiovascular; Catheters; Child; Child, Preschool; Clinical outcomes; Female; Follow-Up Studies; Heart Septal Defects, Atrial - mortality; Heart Septal Defects, Atrial - physiopathology; Heart Septal Defects, Atrial - therapy; Heart surgery; Hemodynamics - physiology; Humans; Infant; Male; Middle Aged; Retrospective Studies; Septal Occluder Device; Survival Rate - trends; Time Factors; Treatment Outcome; United States - epidemiology; Young Adult
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.12.031

Truly long-term follow-up data after transcatheter closure (TC) of atrial septal defects (ASDs) are scarce. We report the 5- to 20-year outcomes of TC and surgical closure (SC) for typical secundum ASD. We reviewed the records of patients with isolated secundum ASD and right ventricular volume overload who underwent TC or SC (January 1, 1986 to September 30, 2005). Follow-up was obtained through a combination of chart review, physician records, and telephone survey. We identified 375 patients (207 SC and 168 TC) and obtained follow-up data >5 years (median follow-up 10 years) for 300 (152 SC, 148 TC). Nine patients have died (3%). The New York Heart Association functional class was unchanged in 227 patients, improved in 25, and was worse in 15. Clinically significant arrhythmia was found in 28 patients (9.3%); 21% aged >40 years developed arrhythmia. On multivariate analysis, the odds of significant arrhythmia tended to be greater in the SC group, but this was statistically insignificant (95% confidence interval 0.68 to 3.9, p = 0.27). Age and preprocedure arrhythmia, but not TC or SC, were independent risk factors for late arrhythmia (p