Long-term follow-up after surgical repair of ostium primum atrial septal defects in adults

Boston Adult Congenital Heart Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

OBJECTIVES: We sought to determine the long-term survival rates and defect-related morbidity of adult patients who undergo surgical repair of an ostium primum atrial septal defect. BACKGROUND: The natural history of patients undergoing such surgical repair in adulthood remains unclear. METHODS: We followed up 33 patients who underwent surgical correction of an ostium primum atrial septal defect at our institution at a mean age of 42 years (range 20 to 73); 12 of these patients were > 50 years old at the time of operation. Four patients had moderate preoperative exercise incapacity (New York Heart Association functional class > II) and six had atrial fibrillation. Nine and four patients, respectively, had a preoperative mean pulmonary artery pressure > 25 mm Hg or pulmonary vascular resistance > 4 Wood U. Autologous pericardium was used to patch the defect in 30 patients (91%). Mitral valvuloplasty, consisting of cleft repair (n = 10), and mitral valve replacement (n = 2) were performed selectively. RESULTS: There were no operative deaths. At a mean follow-up interval of 5.3 years (range 1 to 18.2), all 28 surviving patients are free of exercise limitation (functional class 1). Late postoperative deaths occurred in five patients (15%) and were related to myocardial infarction, stroke, hepatic failure, renal failure or sepsis. Reoperation within the 1st postoperative year was required in two patients (6%) because of a residual ostium primum defect in one and severe mitral regurgitation in the other. The presence of advanced age at operation, symptoms, atrial arrhythmias, mitral regurgitation or moderately increased pulmonary vascular resistance did not predict late postoperative mortality, complications or functional capacity. CONCLUSIONS: An ostium primum defect can be repaired in adult patients with the expectation of excellent long-term results, independent of age at operation and preoperative mitral valve function and despite the presence of atrial fibrillation or moderately elevated pulmonary vascular resistance.

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