Surgical closure of atrial septal defect in patients older than 30 years: Risk factors for late death from arrhythmia or heart failure

Background: Little is known about prognostic markers for late cardiac-related death after surgical atrial septal defect (ASD) closure in adults. Methods: Long-term follow-up data of 281 patients who underwent surgical secundum ASD closure when they were older than 30 years, were retrospectively examined. Results: Mean age at surgery was 43.8 ± 10.0 years (30 to 76 years). There were 2 early deaths. Mean follow-up was 14.1 ± 8.4 years (0.4 to 28.9 years). Death from arrhythmia or heart failure occurred in 9 patients (3.6%) at a mean time of 8.5 ± 6.6 years after the operation. Patients > 43 years exhibited significantly higher pulmonary artery pressures. Preoperative systolic pulmonary artery pressure > 36 mmHg, and mean pulmonary artery pressure > 21 mmHg were predictive of late death from arrhythmia or heart failure. However, age at operation was not. Conclusions: Older age at the time of ASD closure is not a risk factor for late death from arrhythmia or heart failure in adults. However, older patients presented more often with pulmonary hypertension. Since elevated pulmonary artery pressure is predictive of late death from arrhythmia or heart failure, timely ASD closure is warranted.