Age at repair affects outcome of secundum atrial septal defects: benchmark for trans-catheter therapy

  • Dr Elisabetta Zorzi, Division of Cardiology, University of Verona, Verona, Italy, Italy
  • Dr Mara Pilati, Division of Cardiology, University of Verona, Verona, Italy, Italy
  • Dr Francesca Viscardi, Division of Cardiac Surgery, University of Verona, Verona, Italy, Italy
  • Dr Maria Antonia Prioli, Division of Cardiology, University of Verona, Verona, Italy, Italy
  • Dr Luca Barozzi, Division of Cardiac Surgery, University of Verona, Verona, Italy, Italy
  • Prof Corrado Vassanelli, Division of Cardiology, University of Verona, Verona, Italy, Italy
  • Prof Alessandro Mazzucco, Division of Cardiac Surgery, University of Verona, Verona, Italy, Italy
  • Prof Giovanni Battista Luciani, Division of Cardiac Surgery, University of Verona, Verona, Italy, Italy

    • Objective. To define the very-long term history of surgically repaired secundum atrial septal defect (ASD) in the trans-catheter therapy era.
    Methods. All consecutive patients who underwent repair of isolated ASD between 1970 and 2007 were assessed directly or by telephone interview. Hospital records and death certificates were obtained if interim hospitalization or death had occurred.
    Results. Two-hundred-twenty-two patients (152 female, 68%), had repair at a mean age of 22±19 years (range 1-70 years) with no hospital mortality. During follow-up (mean 14±8, range 1-36 years) 14 deaths occurred, 4 due to cardiac cause. Actuarial 30-year survival and freedom from cardiac death were 86±4% and 96±2%, respectively. Symptomatic SVT were present in 38 patients (17%) and 9 patients (4%) required pacing. At follow-up 196 patients (88%) were in NYHA class I, 19 (8%) in II, 7 (3%) III and 2 (1%) in IV. Thirty-three patients (15%) were on cardiac medication, 14 on warfarin. Multivariate analysis showed older age at operation (p=0.01) as independent predictor of major cardiovascular events.
    Conclusions. Very-long term outcome after ASD repair shows excellent survival and low morbidity, which represent the current gold standard for trans-catheter therapy. Considering the association between older age at repair and late morbidity, choice between surgical and trans-catheter approach must not delay repair beyond early childhood.