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A Comparison of Surgical and Medical Therapy for Atrial Septal Defect in Adults
Open accessAbstract
BACKGROUND: The surgical closure of an atrial septal defect is frequently recommended for patients over 40 years of age. However, the prognosis for such patients with unrepaired defects is largely unknown, and the outcome for patients operated on after the fourth decade of life has not yet been compared with that for medically treated patients in a controlled follow-up study. METHODS: In a retrospective study, we examined the clinical course of 179 consecutive patients with isolated atrial septal defects diagnosed after the age of 40. The 84 patients (47 percent) who underwent surgical repair were compared with the 95 patients (53 percent) who were treated medically. The mean (+/-SD) follow-up period was 8.9 +/- 5.2 years (range, 1 to 26). RESULTS: Multivariate analysis revealed that surgical closure of the defect significantly reduced mortality from all causes (relative risk, 0.31; 95 percent confidence interval, 0.11 to 0.85). The adjusted 10-year survival rate of surgically treated patients was 95 percent, as compared with 84 percent for the medically treated patients. In addition, surgical treatment prevented functional deterioration, as measured by the New York Heart Association class (relative risk, 0.21; 95 percent confidence interval, 0.08 to 0.55). However, the incidence of new atrial arrhythmias or of cerebrovascular insults in the two groups was not significantly different. CONCLUSIONS: The surgical repair of an atrial septal defect in patients over 40 years of age, as compared with medical therapy, increases long-term survival and limits the deterioration of function due to heart failure. However, surgically treated patients should be followed closely for the onset of atrial arrhythmias so as to reduce the risk of thromboembolic complications.
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“However, significant ASDs in adults can be closed even later in life with consequent improved morbidity and survival, 359 albeit new or recurrent ATs are frequent.360”
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 [359]
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Metadata
- Authors
- Konstantinides, S., Geibel, A., Olschewski, M., Görnandt, L., Roskamm, H., Spillner, G., Just, H., & Kasper, W.
- Affiliations
- University of Freiburg (DE)
- University Medical Center Freiburg (DE)
- Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE)
- St. Josefs Hospital (DE)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1995-08-24
- Volume
- 333
- Issue
- 8
- Pages
- 469-473
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2033239948
- Cited by
- 406
- References
- 21
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 11 · 2021: 7 · 2020: 7 · 2019: 11 · 2018: 12 · 2017: 14 · 2016: 11 · 2015: 15 · 2014: 11 · 2013: 14 · 2012: 23
- FWCI
- 8.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac Structural Anomalies and Repair
- Keywords
- atrial septal defect, surgical closure, medical therapy, adults, long-term survival, mortality, heart failure, functional decline, atrial arrhythmias, thromboembolism
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Digitalis Glycosides, Diuretics, Female, Heart Septal Defects, Atrial, Humans, Male, Middle Aged, Nitrates, Postoperative Complications, Retrospective Studies, Risk, Severity of Illness Index, Incidence, Multivariate Analysis, Proportional Hazards Models, Survival Analysis
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