The influence of pulmonary artery pressure on early and late outcome after operative closure of ASD in GUCH-patients

Objectives: ASD closure in GUCH-patients may be complicated by the risk of pulmonary hypertension. In some cases staged closure has even been proposed. We evaluated our

Methods: In a retrospective study, we examined long-term follow-up of 274 patients (pts.) aged 30–76 years, mean age 44.0±9.8 years, who underwent operation for secundum ASD between 1974 and 2000. 198 pts. with systolic pulmonary artery pressure λε 35mmHg (72.3%, group 1) were compared to 76 pts. with systolic pulmonary artery pressure >35mmHg (27.7%, group 2).

Results: Mean follow-up was 15.5±8.3 years (88% complete). Age at the operation was 42.4±9.0 in group 1 and 48.1±10.7 in group 2 (p=0.001). One patient of group 1 died early postoperatively. In this patient systolic pulmonary artery pressure was 28mmHg. One patient of group 2 died intraoperatively (systolic pulmonary artery pressure: 47mmHg). Both groups did not differ in length of ICU-stay (p=0.221), however patients of group 2 needed more inotropic support postoperatively (p=0.005). At time of follow-up significantly more cardiac related deaths could be observed in group 2 (7 of 67 pts. 10.4%) compared to group 1 (5 of 174 pts. 2.9%, p=0.015).

Conclusion: ASD closure in GUCH-patients can be performed with low early mortality and morbidity in a one stage approach. Our data indicate that elevated pulmonary artery pressure and higher age at operation are no risk factors for early morbidity or mortality. However, elevated pulmonary artery pressure is associated with a higher cardiac related mortality at long-term. Therefore, we recommend ASD closure as a one stage approach at earlier age, before pulmonary artery pressure has risen above 35mmHg.