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Cited by 776Congenital Heart Disease StudiesCardiovascular and Diving-Related ComplicationsCardiac Structural Anomalies and Repair

Long-Term Outcome after Surgical Repair of Isolated Atrial Septal Defect: Follow-up at 27 to 32 Years

Murphy, Joseph G., Gersh, Bernard J., McGoon, Michael D., Mair, Douglas D., Porter, Co-burn J., Ilstrup, Duane M., McGoon, Dwight C., Puga, Francisco J. +2 more·1990·New England Journal of Medicine
DOI 10.1056/nejm199012133232401
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Abstract

BACKGROUND: Atrial septal defects have been surgically correctable for more than 30 years. The long-term survival rates among patients treated in the early era of cardiac surgery are poorly documented, but such data are of critical importance to the future medical care, employability, and insurability of these patients. METHODS: To determine the natural history of surgically corrected atrial septal defects, we studied all 123 patients who underwent repair of an isolated defect (ostium secundum or sinus venosus) at the Mayo Clinic between 1956 and 1960, 27 to 32 years after the procedure. The follow-up status of all patients was determined by written questionnaires and telephone interviews. Hospital records and death certificates were obtained if interim hospitalization or death had occurred. RESULTS: The overall 30-year actuarial survival rate among survivors of the perioperative period was 74 percent, as compared with 85 percent among controls matched for age and sex. The perioperative mortality was 3.3 percent (four deaths). Actuarial 27-year survival rates among patients in the younger two quartiles according to age at operation (less than or equal to 11 years and 12 to 24 years) were no different from rates among controls--97 percent and 93 percent, respectively. In the two older quartiles (25 to 41 years and greater than 41 years), 27-year survival rates were significantly less (P less than 0.001)--84 percent and 40 percent, respectively--than in controls (91 and 59 percent). Independent predictors of long-term survival according to multivariate analysis were age at operation (P less than 0.0001) and systolic pressure in the main pulmonary artery before operation (P less than 0.0027). When repair was performed in older patients, late cardiac failure, stroke, and atrial fibrillation were significantly more frequent. CONCLUSIONS: Among patients with surgically repaired atrial septal defects, those operated on before the age of 25 have an excellent prognosis, but older patients require careful, regular supervision.

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Authors
Murphy, J. G., Gersh, B. J., McGoon, M. D., Mair, D. D., Porter, C.-B. J., Ilstrup, D. M., McGoon, D. C., Puga, F. J., Kirklin, J. W., & Danielson, G. K.
Affiliations
Mayo Clinic (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1990-12-13
Volume
323
Issue
24
Pages
1645-1650
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199012133232401
OpenAlex
W2066441394
Cited by
776
References
31
Citations by year
2026: 11 · 2025: 18 · 2024: 23 · 2023: 23 · 2022: 22 · 2021: 21 · 2020: 29 · 2019: 18 · 2018: 24 · 2017: 36 · 2016: 33 · 2015: 28 · 2014: 36 · 2013: 25 · 2012: 34
FWCI
11.58
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
  • Health Sciences › Medicine › Surgery › Cardiac Structural Anomalies and Repair
Keywords
atrial septal defect, surgical repair, long-term survival, age at surgery, sinus venosus atrial septal defect, secundum atrial septal defect, stroke, atrial fibrillation, pulmonary artery systolic pressure
MeSH terms
Actuarial Analysis, Adolescent, Adult, Age Factors, Child, Child, Preschool, Female, Follow-Up Studies, Heart Septal Defects, Atrial, Hemodynamics, Humans, Male, Middle Aged, Prognosis, Survival Rate

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