Short‑to‑mid‑term follow‑up results of transcatheter closure of atrial septal defect in patients older than 60 years

Abstract

Aim. To assess short-to-mid-term clinical and echocardiographic outcomes and identify factors associated with pulmonary arterial hypertension (PAH) in patients older than 60 years.Material and methods. Retrospective single-center study of 51 consecutive patients (mean age 63,3±3,2 years, 76% females) undergoing percutaneous ASD closure. Functional status, right ventricular (RV) remodeling and pulmonary artery systolic pressure (PASP) was assessed before and 24 hours after the procedure, at 6 months and 12 months.Results. The mean ASD size was 21,8±4,4 mm. Compared to before procedure, at 24 hours a significant improvement of NYHA class (NYHA II-III 7 (13,7%) vs. 34 (66,7%) patients, p<0,0001, respectively), RV size (26,9±5,7 vs. 31,3±5,7 mm, p<0,0001, respectively) and PASP (26,9±5,7 vs. 50,4±14,2 mm Hg, p<0,001) was detected. At 1 year, RV size and PASP decreased to 22±4,6 mm, p<0,0001 and 33,8±10,8 mm Hg, p<0,0001, respectively, compared to before ASD closure, PAH remained in 10 (19,6%) patients. Pre-intervention PASP ≥57,5 mm Hg was an independent predictor of residual PAH at 1 year (odds ratio 1,31, 95% confidence interval (CI) 1,04-1,67, p=0,024; c-statistics 0,939, 95% CI 0,865-1,0, p<0,001, sensitivity 80%, specificity 92,6%).Conclusion. Percutaneous ASD closure in elderly patients was associated with regression of RV size and PASP, as well as symptomatic improvement in the short- and medium-term. Pre-intervention PASP was an independent predictor associated with residual PAH after one year.

Keywords

• atrial septal defect
• percutaneous closure
• elderly
• pulmonary arterial hypertension