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Complete Atrioventricular Septal Defects after the Age of 40 Years
Susanne J Maurer1, Lorena Moosholzer2, Claudia Pujol2
1Department of Electrophysiology, German Heart Centre Munich, TUM School of Medicine, Technical University of Munich, 80636 Munich, Germany.
Insights
Older adults with complete atrioventricular septal defects (cAVSD) face significant health risks. New York Heart Association (NYHA) class predicts worse outcomes, highlighting the need for careful management in this growing population.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Adult Congenital Heart Disease
Background:
- Increasing prevalence of adults with complete atrioventricular septal defects (cAVSD).
- Limited data available on the outcomes of older adults diagnosed with cAVSD.
- Growing population of adults with cAVSD necessitates understanding long-term health trajectories.
Purpose of the Study:
- To analyze the clinical outcomes of adults aged 40 years and older with cAVSD.
- To identify predictors of morbidity and mortality in this specific patient group.
- To inform clinical management strategies for older adults with cAVSD.
Main Methods:
- Retrospective analysis of patients with cAVSD aged ≥40 years between 2005 and 2018.
- Data extraction from hospital records.
- Primary endpoint defined as all-cause death or unplanned cardiac hospitalizations.
Main Results:
- 43 patients (60.5% female, mean age 43.7 years) were included; 58.1% had genetic syndromes.
- Most patients (95.3%) were in NYHA class I or II at baseline; 60.5% had prior cardiac surgery.
- 93.0% had at least one extracardiac comorbidity; NYHA class predicted the primary endpoint (HR 1.96, p<0.05).
Conclusions:
- Adults with cAVSD over 40 years experience significant morbidity and mortality.
- New York Heart Association (NYHA) functional class is a key predictor of adverse outcomes.
- Clinical monitoring and management should consider functional class in older cAVSD patients.
Background:
There is an increasing number of adults with complete atrioventricular septal defects (cAVSD). However, data regarding older adults are lacking. The aim of this study is to analyze the outcome of adults with cAVSD over the age of 40 years.
Methods:
Patients with cAVSD who were ≥40 years of age at any point between 2005 until 2018 were included retrospectively. Data were retrieved from hospital records. The primary endpoint was a combination of death from any cause and unplanned hospitalizations due to cardiac reasons.
Results:
43 patients (60.5% female, mean age 43.7 ± 6.0 years, genetic syndrome 58.1%) were included. At begin of follow-up, the majority of patients (n = 41, 95.3%) was in New York Heart Association (NYHA) class I or II. Out of the whole cohort 26 (60.5%) had undergone cardiac surgery. At baseline, at least one extracardiac comorbidity was present in 40 patients (93.0%). Median follow-up was 1.7 years (IQR 0.3-4.6). On univariate Cox analysis, NYHA class at begin of follow-up (hazard ratio: 1.96, CI 95%: 1.04-3.72, p < 0.05) was the only predictor for the primary endpoint.
Conclusions:
Significant morbidity and mortality is present in cAVSD patients over the age of 40 years. NYHA class is predictive for a worse outcome.
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