Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery

• Published in: International journal of cardiology Vol. 397; p. 131616
• Main Authors: Kauling, Robert M, Pelosi, Chiara, Cuypers, Judith A A E, van den Bosch, Annemien E, Hirsch, Alexander, Carvalho, João G, Bowen, Daniel J, Kardys, Isabella, Bogers, Ad J J C, Helbing, Wim A, Roos-Hesselink, Jolien W
• Format: Journal Article
• Language: English
• Published: Netherlands 15-02-2024
• Subjects: Adolescent; Adult; Arrhythmias, Cardiac - etiology; Cardiac Catheterization - adverse effects; Female; Follow-Up Studies; Heart Septal Defects, Atrial - diagnosis; Heart Septal Defects, Atrial - surgery; Humans; Hypertension - complications; Male; Middle Aged; Quality of Life; Stroke Volume; Treatment Outcome; Ventricular Function, Right; Atrial septal defect; Cardiac surgery; Long-term outcome; Quality of life
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.131616

To describe the clinical outcome and quality of life up to 50 years after surgical atrial septal defect (ASD) closure at young age. Primary outcome is defined as MACE (all-cause mortality, cardiac re-interventions, ischemic stroke, endocarditis, heart failure and symptomatic arrhythmia).
Single-center, longitudinal cohort-study evaluating 135 consecutive patients who underwent ASD-closure before the age of 15 years between 1968 and 1980. Participants were invited for extensive cardiac evaluation and assessment of quality-of-life every 10 years.
Eighty patients (86%) of 93 eligible survivors were included in this study (mean age 52 ± 5 years (range 41-63), 40% male). Median follow-up since surgery was 45 years (range 40-51). Cumulative survival after 50 years was 86% and comparable to the normal Dutch population. Cumulative event-free survival after 45 and 50-years was 59% and 46% respectively (re-intervention in 6, symptomatic arrhythmia in 25, and pacemaker implantation in 10 patients). Right ventricular ejection fraction on CMR was diminished in 6%. Exercise capacity was normal in 77%. There was no pulmonary hypertension. NT-proBNP was elevated in 61%. Quality of life was comparable with the general population. No predictors for late events were identified.
Long-term survival after surgical ASD-closure in childhood is good and not statistically different at 50 years compared to the normal Dutch population. Re-intervention rate is low, there is no pulmonary hypertension. Right ventricular function was diminished in 6%, exercise capacity was good and stable over time with quality of life comparable to the general population. However, supraventricular tachycardia is common.