title: Long-term outcome after transcatheter closure of atrial septal defect in older patients: impact of age at procedure.
abstract: OBJECTIVE
  This study assessed long-term outcome after transcatheter atrial septal defect (ASD) closure in older patients, especially those older than 75 years of age.
  
  
  BACKGROUND
  The clinical benefits of transcatheter ASD closure in this aged population are controversial.
  
  
  METHODS
  A total of 244 patients older than 50 years of age were divided into 3 groups according to age at procedure (50 to 59 years: n=69; 60 to 74 years: n=120; 75 years and older: n=55). The primary endpoint was defined as all-cause mortality and hospitalization due to heart failure or stroke. Improvements in functional capacity and cardiac remodeling after the procedure were also assessed.
  
  
  RESULTS
  During a median follow-up of 36 months, mortality and hospitalization due to heart failure or stroke occurred in 18 patients (7%). Among patients older than 75 years of age, 2 died of noncardiovascular disease, 2 were hospitalized due to heart failure, and 1 had a stroke. More than 90% of patients older than 75 years of age did not experience these events. Kaplan-Meier analysis showed that the event-free survival rate was not different among the 3 age groups (log-rank test, p=0.780). New York Heart Association functional class and right ventricular/left ventricular end-diastolic diameter ratio improved in patients older than 75 years of age, similar to the other age groups.
  
  
  CONCLUSIONS
  Long-term outcome after transcatheter ASD closure in patients older than 75 years of age is similar to that in the other, relatively younger age groups. This suggests that transcatheter ASD closure can be considered a valuable therapeutic option in patients older than 75 years of age.
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaya
authors.affiliation: Cardiac Intensive Care Unit, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan. Electronic address: t-akagi@cc.okayama-u.ac.jp.
authors.forename: Teiji
authors.initials: T
authors.lastname: Akagi
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kijima
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: atrial septal defect; older patients; outcome; transcatheter closure