Long-term follow-up results of adult atrial septal defect population.

backgroundAtrial septal defect (ASD) is a common congenital heart disease (CHD) with significant implications for cardiac function and long-term outcomes in adults. Although ASD often presents in childhood, many cases are diagnosed later in adulthood. Understanding the demographic characteristics, clinical features, and long-term outcomes of adults with ASD is essential for optimizing treatment strategies.

objectivesThis study aimed to evaluate the long-term follow-up outcomes of adult patients with ASD, focusing on survival rates, clinical characteristics, and predictors of mortality.

methodsA retrospective cohort study was conducted, analyzing data from 416 adult ASD patients under follow-up at the Adult Congenital Heart Disease (ACHD) Outpatient Clinic of Istanbul University-Cerrahpasa Institute of Cardiology between 1980 and 2023. Patients were included regardless of treatment status, whether they underwent medical follow-up, percutaneous closure, or surgical closure. Demographic data, clinical characteristics, echocardiographic findings, and hemodynamic parameters were collected. Survival analysis was performed using the Kaplan-Meier method, and Cox regression analysis was used to identify predictors of mortality.

resultsThe study population had a mean age of 48 years, with 71.2% being female. Atrial fibrillation (AF) was present in 13.0% of patients, while pulmonary arterial hypertension (PAH) was observed in 19.7%. Treatment modalities included surgical closure (56.5%), percutaneous closure (15.9%), and medical therapy (27.6%). The median follow-up duration was 3905 days, with a mortality rate of 9.6%. Patients who underwent percutaneous or surgical closure had significantly better survival outcomes compared to those managed with medical therapy alone (p < 0.001). Cox regression analysis identified age, ASD type (non-secundum), and treatment choice (medical therapy) as independent predictors of mortality.

conclusionsThis study underscores the importance of early diagnosis and appropriate treatment in adults with ASD. Percutaneous or surgical closure is associated with improved survival, highlighting the need for timely intervention. Age, ASD type, and treatment choice are crucial predictors of mortality, emphasizing the need for individualized patient management. These findings contribute to the understanding of ASD management and its impact on long-term outcomes in adult patients. Further research should focus on refining risk stratification and optimizing therapeutic strategies for this population.