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Volume 333:469-473 August 24, 1995 Number 8 Next

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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.

Source Information

From the Abteilung Innere Medizin III–Kardiologie (S.K., A.G., H.J.), Abteilung Herz und Gefässchirurgie (G.S.), and Abteilung Medizinische Biometrie und Informatik (M.O.), Universitätsklinik Freiburg, Freiburg; the Herzzentrum Bad Krozingen, Bad Krozingen (L.G., H.R.); and the St. Josef Hospital, Wiesbaden (W.K.) — all in Germany.

Address reprint requests to Dr. Geibel at the Universitätsklinik Freiburg, Innere Medizin III–Kardiologie, Hugstetter Str. 55, D-79106 Freiburg, Germany.

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Atrial Septal Defect
Ward C., Henderson R.A., Sanderson J. E., Fung W.H., Cox J. L., Jaquiss R. D.B., Konstantinides S., Geibel A.
Extract | Full Text  
N Engl J Med 1996; 334:56-57, Jan 4, 1996. Correspondence

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