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Updated: Jun 30, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery
Robert M Kauling1, Chiara Pelosi2, Judith A A E Cuypers1
1Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands.
Insights
Surgical closure of atrial septal defect in childhood offers good long-term survival up to 50 years, comparable to the general population. While re-intervention rates are low, supraventricular tachycardia is common.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Adult Congenital Heart Disease
Background:
- Atrial septal defect (ASD) closure in childhood is a common procedure.
- Long-term outcomes and quality of life after early surgical intervention require comprehensive evaluation.
Purpose of the Study:
- To assess the clinical outcomes and quality of life up to 50 years post-surgical closure of atrial septal defect (ASD) in childhood.
- To evaluate major adverse cardiac events (MACE) including mortality, re-interventions, stroke, heart failure, and arrhythmias.
Main Methods:
- A single-center, longitudinal cohort study included 135 patients who underwent surgical ASD closure before age 15 (1968-1980).
- Participants underwent extensive cardiac evaluations and quality-of-life assessments every 10 years.
- Follow-up extended up to 50 years post-surgery.
Main Results:
- 86% survival at 50 years, comparable to the general Dutch population.
- 59% event-free survival at 45 years and 46% at 50 years; common events included symptomatic arrhythmia (25%) and pacemaker implantation (10%).
- Normal exercise capacity (77%), no pulmonary hypertension, but diminished right ventricular ejection fraction in 6% and elevated NT-proBNP in 61%.
Conclusions:
- Surgical ASD closure in childhood leads to good long-term survival, with outcomes comparable to the general population at 50 years.
- Low re-intervention rates and absence of pulmonary hypertension are favorable.
- Good exercise capacity and quality of life are maintained, but supraventricular tachycardia is a frequent long-term complication.
Objectives:
To describe the clinical outcome and quality of life up to 50 years after surgical atrial septal defect (ASD) closure at young age. Primary outcome is defined as MACE (all-cause mortality, cardiac re-interventions, ischemic stroke, endocarditis, heart failure and symptomatic arrhythmia).
Methods:
Single-center, longitudinal cohort-study evaluating 135 consecutive patients who underwent ASD-closure before the age of 15 years between 1968 and 1980. Participants were invited for extensive cardiac evaluation and assessment of quality-of-life every 10 years.
Results:
Eighty patients (86%) of 93 eligible survivors were included in this study (mean age 52 ± 5 years (range 41-63), 40% male). Median follow-up since surgery was 45 years (range 40-51). Cumulative survival after 50 years was 86% and comparable to the normal Dutch population. Cumulative event-free survival after 45 and 50-years was 59% and 46% respectively (re-intervention in 6, symptomatic arrhythmia in 25, and pacemaker implantation in 10 patients). Right ventricular ejection fraction on CMR was diminished in 6%. Exercise capacity was normal in 77%. There was no pulmonary hypertension. NT-proBNP was elevated in 61%. Quality of life was comparable with the general population. No predictors for late events were identified.
Conclusion:
Long-term survival after surgical ASD-closure in childhood is good and not statistically different at 50 years compared to the normal Dutch population. Re-intervention rate is low, there is no pulmonary hypertension. Right ventricular function was diminished in 6%, exercise capacity was good and stable over time with quality of life comparable to the general population. However, supraventricular tachycardia is common.
