Long-Term Survival of Adult Patients With Atrial Septal Defect With Regards to Defect Closure and Pulmonary Hypertension

Abstract

BackgroundAtrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults and pulmonary hypertension (PH) is an established risk factor. A decision whether to perform ASD closure, especially in elderly patients with PH, is a complex dilemma. The aim of our study was to compare long-term survival in patients with closed and open ASD.MethodsA retrospective cohort study was performed on 427 patients with ASD (median age at diagnosis 38 years, IQR 18–56) out of which 186 patients (44%) manifested PH. ASD closure in patients with PH was only considered in patients without Eisenmenger syndrome with pulmonary vascular resistance < 5 WU. Median follow-up duration was 18 years (IQR 9–31 years). Kaplan-Meier and Cox proportional hazards survival analyses were performed to evaluate 12 potential predictors of survival.ResultsDefect closure was associated with improved long-term survival in ASD patients both with (P < 0.001) and without PH (P = 0.01) and this association was present also in patients over 40 years. The 20-year survival since diagnosis was significantly higher in patients with PH and closed ASD compared to those with PH and open ASD (65% vs. 41%). ASD closure was a significant independent predictor of long-term survival (P = 0.003) after accounting for age at diagnosis, PH, NYHA class, Eisenmenger syndrome, and mitral regurgitation. Significant negative independent predictors of survival were older age at diagnosis (P < 0.001), Eisenmenger syndrome (P < 0.001), and PH (P = 0.03).ConclusionASD closure appears to be associated with improved long-term survival independently of age, PH, and other clinical variables.

Arrhythmic Risk and Treatment after Transcatheter Atrial Septal Defect Closure

“…Several studies demonstrated that mortality is higher for ASD patients than for the general population, and Eisenmenger syndrome, age at diagnosis, and pulmonary hypertension (PH) are independent positive predictors of mortality, while ASD closure is a positive independent predictor of survival [ 54 , 55 ]. SCD is a leading cause of death among adults with CHD, and accounts for up to 25% of deaths [ 56 , 57 , 58 ].…”

The Treatment Strategy for the Atrial Septal Defect in the Presence of Severe Pulmonary Hypertension

“…In the case of ASD, the abnormal blood shunt from left to right occurs and the overload of the right heart and pulmonary artery (PA) emerges. The pressure in PA increases and in most of the cases PAH develops, but also hyperkinetic pulmonary hypertension can occur, which is reversible after the closure of the defect and has a good long term survival [ 4 ]. Rarely, in about 1% of patients with congenital ASD, Eisenmenger’s syndrome occurs because of the progression of PAH [ 5 ].…”