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

The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index.

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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Crossref · 10.1056/nejm199508243330801

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Research works printed but not linked: 3

  1. Markman P, 1965, Q J Med, 34, 409
  2. Foster-Smith KW, 1994, J Am Coll Cardiol, 465A
  3. Konstantinides S, 1994, Circulation, 90, I

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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)
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
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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