Cited by 406Cardiovascular and Diving-Related ComplicationsCongenital Heart Disease StudiesCardiac Structural Anomalies and Repair

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A Comparison of Surgical and Medical Therapy for Atrial Septal Defect in Adults

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Konstantinides, Stavros, Geibel, Annette, Olschewski, Manfred, Görnandt, Lothar, Roskamm, Helmut, Spillner, Gerhard, Just, Hanjörg, Kasper, Wolfgang·1995·New England Journal of Medicine

DOI 10.1056/nejm199508243330801

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Abstract

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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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)
ORCID: Konstantinides, Stavros
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
DOI: 10.1056/nejm199508243330801
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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A Comparison of Surgical and Medical Therapy for Atrial Septal Defect in Adults

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