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- Mayer Bassan, MD, FACCa ()
Attie et al. (1)are to be congratulated for their ambitious randomized study of surgery for secundum atrial septal defect (ASD) in patients over age 40. I believe, however, that their results do not support their recommendation for surgery in this patient group.
The only end point that was significantly less frequent in the surgical group than in the medical group was recurrent pneumonia. This single component of the composite end point accounted for three-quarters of the difference between the two groups. There was no difference between the two groups with respect to heart failure, pulmonary embolism, peripheral embolism, stroke or total mortality (the authors’ attempt to demonstrate a difference in mortality by means of complex statistical manipulation notwithstanding). According to the study, the net gain from the performance of 232 operations for the correction of ASD in patients over age 40 would be the prevention of approximately 18 cases of pneumonia. In my opinion such a benefit is hardly worth the cost and suffering the surgery would cause.
- American College of Cardiology Foundation