Study question: A study by Attie et al. assessed weather surgical treatment of atrial septal defects in patients over age 40 improves their long-term outcome.
Methods: The study included 521 patients over age 40 with atrial septal defect who were randomly assigned to surgical closure or medical treatment.
Results: After approximately seven years of follow-up, surgical closure was superior to medical treatment in improving the composition of major cardiovascular events and overall mortality. Closure of the defect is advisable in patients over age 40 with pulmonary artery pressures less than 70 mmHg and a pulmonary/systemic output ratio greater than 1.7. Sudden death was more common in the medical group than the surgical group. This study shows that nonsurgical closure of the defect is not an option.
A nonrandomized analysis of 442 patients undergoing closure with the Amplatzer septal occluder (ASO) was compared with 154 patients in the surgical group. The ASO consists of two expandable round disks with a 4 mm long connecting waist that is delivered to the site in the left atrium via a catheter threaded through the left upper pulmonary vein. The early primary and secondary benefits for surgical versus device closure were not significantly different. The complication rate, however, was lower and hospital stay was shorter for device closure versus surgical repair. The complication rate was 7.2% for the device group and 24% for the surgical group.

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