The benefit of atrial septal defect closure in elderly patients*

Abstract

ObjectiveClosure of an atrial septal defect in elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defects (ASDs) in elderly patients.Patients and methodsFrom a total of 488 patients with ASDs who underwent transcatheter closure, 75 patients aged over 60 years (45 female, 30 male) with a mean age of 65.3±15.7 (60–75) years were analyzed. All patients had an isolated secundum ASD with a mean pulmonary blood flow:systemic blood flow of 2.84±1.9 (1.5–3.9). Symptom-limited treadmill exercise tests with respiratory gas-exchange analysis and transthoracic color Doppler echocardiographic study, as well as quality of life measured using the Short Form (36) Health Survey (SF-36) were repeated in all patients before the procedure and after 12 months of follow-up.ResultsThe atrial septal device was successfully implanted in all patients (procedure time 37.7±4.5 [13–59] minutes, fluoroscopy time 11.2±9.9 [6–40] minutes). There were no major complications. The defect echo diameter was 17.7±15.8 (12–30) mm. The mean balloon-stretched diameter of ASDs was 22.4±7.9 (14–34) mm. The diameter of the implanted devices ranged from 16 to 34 mm. Significant improvement of exercise capacity was noted at 6 and 12 months after the procedure. Exercise time within 6 months of ASD closure was longer (P<0.001) compared to baseline values, and also oxygen consumption increased (P<0.001). Seven quality-of-life parameters (except mental health) improved at 12-month follow-up compared to baseline data. The mean SF-36 scale increased significantly in 66 (88%) patients, with a mean of 46.2±19.1 (5–69). As early as 1 month after the procedure, a significant decrease of the right ventricular dimension and the right atrium dimension was observed (P<0.001). The right ventricular dimension decreased in 67 patients (89.3%).ConclusionClosure of ASDs in elderly patients caused significant clinical and hemodynamic improvement after percutaneous treatment, which was maintained during long-term follow-up, justifying this procedure in old age.

Utility of Isovolumic Contraction Peak Velocity for Evaluation of Adult Patient Status after Transcatheter Closure of Atrial Septal Defect

“…Exercise tolerance tests, such as cardiopulmonary exercise tests, were not part of this study. As an increase in oxygen consumption after ASD closure and the utility of strain analysis during exercise in asymptomatic patients were reported previously, exercise tolerance tests may well be useful for more precise symptomatic evaluation. Furthermore, the assessment of isovolumic contraction acceleration was not part of this study due to its poor reproducibility.…”

“…Five patients in this study developed newly diagnosed AF during follow‐up, and supraventricular arrhythmias and heart block were common after ASD closure . Although most arrhythmias reportedly occur within 1 month and diminish during long‐term follow‐up, some become permanent .…”

Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings

“…ASD closure in patients >40‐years‐old has been shown to improve survival and functional capacity compared to medical therapy . Although data on survival benefit of ASD closure in patients age > 60 years are still lacking, improvements in functional capacity, ventricular remodeling, and quality of life post‐ASD closure have been reported . In comparison to young adults with large ASDs, concomitant LV diastolic dysfunction should be suspected in this age group, particularly if cardiovascular risk factors are present.…”

A Large Ostium Secundum Atrial Septal Defect in an 88‐Year‐Old Asymptomatic Woman

“…Moreover, it is argued whether ASDs in asymptomatic or mildly symptomatic adults should be closed . The benefits of this procedure, in particular in older adults, are unclear . Recent studies have assessed benefits in long‐term follow‐up after transcatheter ASD closure in older adults, including those aged 75 and older, but this group had higher rates of heart failure and hospitalization than younger individuals .…”