Long-Term Outcomes of Atrial Septal Defect Closure in Adults Older than 50 Years.

There remains ambiguity regarding the benefits of atrial septal defect (ASD) closure in the elderly. This study aimed to assess the long-term outcomes of ASD closure in older patients. All adults aged 50 years and older who were diagnosed with ASD and right heart volume overload between 2010 and 2023 were considered for enrolment into this single-center observational study. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction (MI) and non-fatal stroke. Secondary outcomes included all-cause mortality, individual components of the primary outcome, heart failure hospitalization, NYHA functional class, and atrial arrhythmia. Three-hundred-eleven consecutive patients constituted the study cohort. 179 (57.6%) patients underwent transcatheter device closure, 85 (27.3%) underwent surgical closure and 47 (15.1%) patients opted for medical follow-up. The primary composite outcome was observed in 14 patients (29.8%) in those who did not undergo ASD closure as opposed to 41 patients (15.5%) in those who underwent ASD closure (p < 0.001) over a median follow-up period of 6.7 [3.2, 9.2] years. All-cause deaths and cardiovascular deaths were more frequently observed among those who remained on medical management than in those who underwent ASD closure. ASD closure in patients aged over 50 years conferred a significant benefit with respect to the composite outcome of cardiovascular death, non-fatal MI and non-fatal stroke. ASD closure in the elderly was associated with a reduction in all-cause mortality, heart failure hospitalization rate, and improvement in functional class but did not reduce the incidence of arrhythmia.