Transcatheter device closure of atrial septal defects in patients above age 60

Closure of an atrial septal defect (ASD) mostly causes reverse remodelling of the right heart, a decrease in pulmonary artery pressures (PASP), and improves functional capacity. However, abolition of the left-to-right shunt may be unfavourable in older patients. This study aimed at evaluating patients older than 60 years who underwent ASD closure.

Forty-seven patients (mean age 69 5 years, 19.1% male) with ASD type secundum who underwent transcatheter device closure were included. Echocardiographic data before and after closure were obtained. Follow-up data until the last follow-up visit were retrieved. Age-, gender- and BMI-matched controls were selected. Before closure, ASD patients had a higher right ventricular end-diastolic diameter (RVEDD), right (RA) and left atrial (LA) dimensions, and PASP when compared to controls. After closure, RVEDD and PASP decreased whereas LVEDD and E/A-ratio increased. RVEDD, PASP, LA dimensions, left ventricular ejection fraction (LVEF) and E/A-ratio were higher than controls. NYHA class improved significantly after ASD-closure. During a median follow-up time of 3.3 years, 6 patients died and 16 were hospitalized because of cardiac events.

Device closure in the elderly improved functional capacity, with a decrease, but not a normalization of RV dimensions and PASP, and an increase in LV dimensions, EF and mitral E/A-ratio. Atrial arrhythmias and coronary ischaemic events are common in this population.