Long-term (5- to 20-year) outcomes after transcatheter or surgical treatment of hemodynamically significant isolated secundum atrial septal defect
Abstract
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 <0.001). No difference was found in the incidence of late, probably embolic, stroke in the TC (3%) versus SC (2%) groups. In conclusion, long-term outcomes after secundum ASD closure using modern methods are excellent. No significant differences were found between TC versus SC with regard to survival, functional capacity, atrial arrhythmias, or embolic neurologic events. Arrhythmia and neurologic events remain long-term risks after ASD closure, especially if the patient had pre-existing arrhythmia.
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Long-term outcomes after secundum ASD closure using transcatheter closure and surgical closure are excellent without significant differences with regard to atrial arrhythmias (9.3%), survival, or thromboembolism.
“Long-term outcomes after secundum ASD closure using transcatheter closure and surgical closure are excellent without significant differences with regard to atrial arrhythmias (9.3%), survival, or thromboembolism.382”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [382]
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“001 Echocardiographic data ASD size (mm) 17 (5-38) 18 (5-35) 0.”
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ResultDiagnosis and Treatment of Adults With Congenital Heart Disease
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“Long-term outcomes after ASD closure are favorable, although there remains a risk of arrhythmia with concomitant neurological events after ASD closure [3].”
BackgroundOutcomes After Transcatheter ASD Closure
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“30 Biomarkers reported in this study may be expressed (1) in the heart, in response to altered loading conditions or perioperative injury; (2) in response to metabolic stress; and (3) as part of the general immune response following perioperative injury.”
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“Nowadays, the transcatheter closure of ASDs, using various percutaneous occlusion devices in both children and adults, offers an alternative to surgical treatment due to its better clinical and follow-up results [6–9].”
BackgroundLower Hospital Charges and Societal Costs for Catheter Device Closure of Atrial Septal Defects
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“[13] reported that out of 300 patients with isolated secundum ASD, the NYHA class was unchanged in 227 patients, while others improved or worsened.”
BackgroundPersistent residual shunts after atrial septal defect closure with the Amplatzer septal occluder
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- Authors
- Kutty, S., Hazeem, A. A., Brown, K., Danford, C. J., Worley, S. E., Delaney, J. W., Danford, D. A., & Latson, L. A.
- Affiliations
- Creighton University (US)
- Cleveland Clinic (US)
- University of Nebraska Medical Center (US)
- Corresponding author
- Kutty, Shelby
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-05
- Volume
- 109
- Issue
- 9
- Pages
- 1348-1352
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2123116915
- Cited by
- 84
- References
- 30
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 3 · 2018: 5 · 2017: 10 · 2016: 12 · 2015: 7 · 2014: 11 · 2013: 5 · 2012: 1
- FWCI
- 6.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac Structural Anomalies and Repair
- Keywords
- secundum atrial septal defect, transcatheter closure, surgical closure, long-term outcomes, atrial arrhythmias, stroke, right ventricular volume overload, NYHA functional class, survival, risk factors
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Follow-Up Studies, Cardiac Catheterization, Heart Septal Defects, Atrial, Hemodynamics, Humans, Infant, Male, Middle Aged, Retrospective Studies, Time Factors, United States, Survival Rate, Treatment Outcome, Age Distribution, Young Adult, Septal Occluder Device
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