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. 2021 Mar 8;14(5):566-575.
doi: 10.1016/j.jcin.2020.12.029. Epub 2021 Mar 1.

Long-Term Outcomes After Atrial Septal Defect Transcatheter Closure by Age and Against Population Controls

Lusine Abrahamyan  1 , Christoffer Dharma  2 , Sami Alnasser  3 , Jiming Fang  2 , Peter C Austin  2 , Douglas S Lee  4 , Mark Osten  5 , Eric M Horlick  6
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Free article

Long-Term Outcomes After Atrial Septal Defect Transcatheter Closure by Age and Against Population Controls

Lusine Abrahamyan et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The long-term outcomes after transcatheter closure of atrial septal defects (ASD) in adults are reported and compared between age groups and against population control patients.

Background: ASD is the second most common lesion in congenital heart disease. Comprehensive data on long-term outcomes after ASD closure are limited.

Methods: This retrospective cohort study enrolled adult patients with secundum ASD closure between 1998 and 2016. Information from a detailed clinical registry was linked to population-based administrative databases to capture outcomes. The population control cohort was matched using important prognostic characteristics.

Results: The cohort included 1,390 ASD patients of whom 32% were <40 years of age, 45% were 40 to 60 years of age, and 23% were >60 years of age at closure. The median follow-up was 10.6 years (interquartile range: 6.2 to 14.0 years). New-onset atrial fibrillation (AF) was the most frequent outcome overall (14.9%). The incidence of adverse cardiac and cerebrovascular events was higher in the >60 years of age group than in the younger groups. In adjusted analysis, patients >60 years of age continued exhibiting higher risk of all-cause (hazard ratio [HR]: 8.54; 95% confidence interval [CI]: 93.40 to 21.43) and cardiovascular (CV)-specific mortality compared with the <40 years of age group. The risk of new-onset AF (HR: 3.73; 95% CI: 2.79 to 4.98) and any AF hospitalization (HR: 1.55; 95% CI: 1.28 to 1.89) was higher in the ASD than in the control population, whereas there was no difference in all-cause and CV-specific mortality.

Conclusions: As expected, rates of adverse events post-ASD closure are higher in older age groups, but long-term mortality was comparable to that of a population control cohort. The high rates of AF necessitate future investigations.

Keywords: age; atrial septal defect; outcomes; survival; transcatheter closure.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the Peter Munk chair in Structural Heart Disease Intervention. ICES is supported in part by a grant from the Ontario Ministry of Health and Long-Term Care. The opinions, results, and conclusions are those of the authors, and no endorsement by the Ministry of Health and Long-Term Care or by ICES is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of CIHI. Dr. Lee is supported by a mid-career investigator award from the Heart and Stroke Foundation and the Ted Rogers Chair in Heart Function Outcomes, a joint Hospital-University Chair of the University Health Network and the University of Toronto. Dr. Austin is supported by a Mid-Career investigator award from the Heart and Stroke Foundation. Dr. Horlick is supported by the Peter Munk Chair in Structural Heart Disease Intervention. Drs. Osten and Horlick have been consultants for Abbott. The Peter Munk Cardiac Centre receives support from Abbott for its educational mission. Dr. Horlick has received research grants from Abbott for other projects. Abbott was not involved in planning or execution of this analysis and has not seen or reviewed this manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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