Risk factors for prolonged intensive care treatment following atrial septal defect closure in adults.
BACKGROUND
Today, percutaneous or surgical closure of atrial septal defects (ASD) in adults are considered effective and safe treatments. However, some cases of severe left ventricular dysfunction after ASD closure were observed. This study aims at identifying predictors for prolonged intensive care unit stay, and postoperative inotropic support after ASD closure.


METHODS
Records of 281 adult patients who had undergone surgical closure of a secundum ASD between 1974 and 2000 at an age over 30 years (mean 43.8, maximum 76 years) were reviewed retrospectively. The endpoints were defined as prolonged intensive care unit stay (>2 days), and postoperative inotropic support (Dopamine, Dobutamine or Adrenalin).


RESULTS
Thirty-day mortality rate was 0.7% (2 patients). Prolonged intensive care unit stay was observed in 70 patients (25%). Postoperative inotropic support was necessary in 84 patients (30%). Independent risk factors for prolonged intensive care unit stay in multivariate analysis were preoperative atrial fibrillation (p=0.011), and larger ASD (p=0.026). Older age at operation (p<0.001) and longer time on extracorporeal circulation (p<0.001) emerged as independent risk factor for postoperative use of inotropic support in multivariate analysis.


CONCLUSIONS
Surgical ASD closure in adults is usually safe. However, a distinct subgroup of patients is at risk for prolonged intensive care treatment. Timely closure of the ASD must be advised since older age emerged as a predictor for postoperative use of inotropic support. Since atrial fibrillation is a strong independent risk factor for prolonged intensive care unit stay the preservation of sinus rhythm must be aimed at.
Hörer
Jürgen
J
Department of Cardiovascular Surgery, German Heart Center Munich at Technical University, Lazarettstrasse. 36, D-80636 Munich, Germany. hoerer@dhm.mhn.de
Eicken
Andreas
A
Müller
Stefan
S
Schreiber
Christian
C
Cleuziou
Julie
J
Prodan
Zsolt
Z
Holper
Klaus
K
Lange
Rüdiger
R
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D002316:Cardiotonic Agents