Mortality Rates for ASD and VSD Closure
The mortality rate for percutaneous device closure of atrial septal defects is near zero in patients without pulmonary hypertension, while surgical ASD closure has a mortality rate of approximately 0-1% in adults without significant comorbidities. 1
Atrial Septal Defect (ASD) Closure Mortality
Percutaneous Device Closure
- Mortality rate: Near zero in patients without pulmonary hypertension 1
- Major complications: 1.5-1.6% 1
- Minor complications: 6-7% 1
- Device closure has become the first choice for secundum defect closure when feasible (80% of patients) 2
Surgical ASD Closure
- Several recent studies have reported no mortality for surgical ASD closure in adults 2
- Mortality may be higher in elderly patients (>60 years) and those with comorbidities 2
- For isolated single and double valve replacement, operative mortality is around 8.6% 3
- For isolated aortic valve replacement specifically, mortality approaches zero 3
Ventricular Septal Defect (VSD) Closure Mortality
- Limited specific data on isolated VSD closure mortality in adults
- In infants and children with elevated pulmonary vascular resistance and pulmonary hypertension, early mortality is approximately 6.25% 4
- Combined, extensive cardiac procedures have higher mortality rates (around 30.5%) 3
Factors Affecting Mortality Risk
Hospital Volume
- Procedures performed at high-volume hospitals (>38 procedures/year) are associated with significantly reduced complications compared to low-volume centers (<13 procedures/year) 5
- 70.5% of hospitals perform <10 procedures/year, deviating from ACC/AHA/SCAI clinical competency guidelines 5
Patient Characteristics
- Age: Patients over 40-60 years have higher mortality risk 2, 3
- Pulmonary hypertension: Significantly increases mortality risk 2, 4
- Eisenmenger physiology: ASD closure must be avoided in these patients (Class III recommendation) 2
- Comorbidities: Increase mortality risk, particularly in elderly patients 2, 3
Timing of Intervention
- Best outcomes occur with repair before age 25 years 2
- Patients benefit from closure at any age regarding morbidity (exercise capacity, shortness of breath, right heart failure) 2
- ASD closure after age 40 does not affect frequency of arrhythmia development during follow-up 2
Comparative Effectiveness
- Studies comparing surgery and catheter intervention have reported similar success rates and mortality 2
- Morbidity is lower and hospital stay shorter with catheter intervention 2
- Device closure is indicated as the preferred method for secundum ASD closure when anatomically suitable (Class I recommendation) 2, 1
Mortality Benefit of Closure
- Limited data available to definitively determine the impact of ASD repair on mortality rate in adults 2
- Pooled analysis shows ASD closure is associated with a weak protective effect on adjusted mortality rate 2
- Early natural history studies showed that nearly 25% of patients with unoperated ASDs died before age 27 and 90% by age 60 2
When considering intervention for ASD or VSD, device closure should be prioritized when anatomically suitable, and intervention should occur earlier rather than later in life to minimize mortality risk, especially before age 25 for optimal outcomes.