Jeong In-Seok, Ahn Byoung-Hee, Kim Soon-Jin, Oh Sang-Gi, Oh Bong-Suk, Kim Sang-Hyung
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Korea.
Korean J Thorac Cardiovasc Surg. 2011 Apr;44(2):137-41. doi: 10.5090/kjtcs.2011.44.2.137. Epub 2011 Apr 14.
There is controversy about the benefit of surgical correction of an atrial septal defect (ASD) in patients over 60 years old. The purpose of this study was to determine whether surgical treatment is beneficial in those 60 years of age or older.
We reviewed the clinical course of 57 patients (mean age: 63.54±5.59 years) diagnosed with an isolated secundum ASD after the age of 60. The 24 patients (group A) who underwent surgical repair were compared with the 33 patients (group B) who were treated non-surgically. The mean follow-up period was 6.8±4.5 years.
One operative death, 5 late deaths (20.8%) in group A, and 9 deaths (27.3%) in group B occurred in the study period. Symptomatic improvement was noted in 18 patients (75%) of group A after surgery. However 13 patients (39.4%) of group B showed symptomatic improvement during the follow-up period (p=0.012). The incidence of new atrial arrhythmia of the two groups was significantly different (16.7% vs 36.7%, p=0.038). The actuarial 10 year survival rate was 79% in group A and 73% in group B.
Although surgical correction of ASD did not increase survival in patients over 60 years old, the surgical outcomes of ASD showed low operative mortality and resulted in symptomatic improvement in the majority of these patients. This study has shown the benefits of surgical closure of ASD even in advanced age in comparison to medical treatment.
对于60岁以上房间隔缺损（ASD）患者手术矫正的益处存在争议。本研究的目的是确定手术治疗对60岁及以上患者是否有益。
我们回顾了57例60岁后被诊断为单纯继发孔型ASD患者的临床病程。将接受手术修复的24例患者（A组）与33例接受非手术治疗的患者（B组）进行比较。平均随访期为6.8±4.5年。
在研究期间，A组发生1例手术死亡、5例晚期死亡（20.8%），B组发生9例死亡（27.3%）。A组18例患者（75%）术后症状改善。然而，B组13例患者（39.4%）在随访期间症状改善（p=0.012）。两组新发房性心律失常的发生率有显著差异（16.7%对36.7%，p=0.038）。A组的10年精算生存率为79%，B组为73%。
尽管ASD手术矫正并未提高60岁以上患者的生存率，但ASD手术结果显示手术死亡率低，且大多数患者症状改善。本研究表明，与药物治疗相比，即使是高龄患者，ASD手术闭合也有益处。
