{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T00:16:30Z","timestamp":1769300190974,"version":"3.49.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The long-term clinical benefits of atrial septal defect (ASD) closure remain controversial. We aimed to compare long-term clinical outcomes between patients who underwent early surgical closure after ASD diagnosis and those who did not.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Using the Korean National Health Insurance Service database, we identified patients with isolated ASDs diagnosed between 1 January 2003 and 31 December 2006. The ASD patients who underwent closure surgery within 6 months after diagnosis were allocated to the early-closure group and the rest were allocated to the conservative-strategy group. The primary outcome was all-cause mortality. Secondary outcomes were atrial flutter\/fibrillation (AFF) and ischaemic stroke.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Among patients without a history of AFF or stroke, 1644 patients in the early-closure group were propensity score matched to 1644 patients in the conservative-strategy group and their median follow-up durations were 12.9 and 12.8 years, respectively. The early closure was associated with a significantly lower risk of mortality (hazard ratio, 0.55 [95% confidence interval, 0.43\u20130.70]). In an age-stratified analysis, significant mortality reductions in the early-closure group were found in patients aged 40 years or older. The risk of AFF was significantly higher in the early-closure group, which might be mainly ascribed to postoperative transient AFF, while there was no difference in ischaemic stroke between the 2 groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Our data suggest that timely ASD closure without delay is necessary for ASD patients without previous history of clinical events, especially in patients aged 40 years or older.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezac076","type":"journal-article","created":{"date-parts":[[2022,1,29]],"date-time":"2022-01-29T12:08:28Z","timestamp":1643458108000},"source":"Crossref","is-referenced-by-count":4,"title":["Clinical outcomes of early closure versus conservative strategy after diagnosis with atrial septal defect: a nationwide population-based cohort study"],"prefix":"10.1093","volume":"62","author":[{"given":"Sun-Yang","family":"Min","sequence":"first","affiliation":[{"name":"Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea"},{"name":"Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8194-3462","authenticated-orcid":false,"given":"Ji Sung","family":"Lee","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea"},{"name":"Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6643-0239","authenticated-orcid":false,"given":"Duk-Woo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6754-8199","authenticated-orcid":false,"given":"Jong-Min","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"key":"2022072905394101100_ezac076-B1","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1016\/S0735-1097(02)01886-7","article-title":"The incidence of congenital heart disease","volume":"39","author":"Hoffman","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2022072905394101100_ezac076-B2","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1136\/hrt.32.6.820","article-title":"Natural history of atrial septal defect","volume":"32","author":"Campbell","year":"1970","journal-title":"Br Heart J"},{"key":"2022072905394101100_ezac076-B3","first-page":"e698","article-title":"2018 AHA\/ACC Guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"139","author":"Stout","year":"2019","journal-title":"Circulation"},{"key":"2022072905394101100_ezac076-B4","doi-asserted-by":"crossref","first-page":"2915","DOI":"10.1093\/eurheartj\/ehq249","article-title":"ESC Guidelines for the management of grown-up congenital heart disease (new version 2010)","volume":"31","author":"Baumgartner","year":"2010","journal-title":"Eur Heart J"},{"key":"2022072905394101100_ezac076-B5","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1016\/S0735-1097(01)01635-7","article-title":"Surgical treatment for secundum atrial septal defects in patients &gt;40 years old. A randomized clinical trial","volume":"38","author":"Attie","year":"2001","journal-title":"J Am Coll Cardiol"},{"key":"2022072905394101100_ezac076-B6","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1056\/NEJM199508243330801","article-title":"A comparison of surgical and medical therapy for atrial septal defect in adults","volume":"333","author":"Konstantinides","year":"1995","journal-title":"N Engl J Med"},{"key":"2022072905394101100_ezac076-B7","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1161\/01.CIR.64.2.402","article-title":"Atrial septal defect in patients ages 60 years or older: operative results and long-term postoperative follow-up","volume":"64","author":"John Sutton","year":"1981","journal-title":"Circulation"},{"key":"2022072905394101100_ezac076-B8","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1093\/eurheartj\/ehx687","article-title":"Long-term mortality in patients with atrial septal defect: a nationwide cohort-study","volume":"39","author":"Nyboe","year":"2018","journal-title":"Eur Heart J"},{"key":"2022072905394101100_ezac076-B9","doi-asserted-by":"crossref","first-page":"137","DOI":"10.5090\/kjtcs.2011.44.2.137","article-title":"Mid- to long-term results of surgical treatment of ASD in patients over 60 years old","volume":"44","author":"Jeong","year":"2011","journal-title":"Korean J Thorac Cardiovasc Surg"},{"key":"2022072905394101100_ezac076-B10","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1136\/hrt.71.3.224","article-title":"Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study","volume":"71","author":"Shah","year":"1994","journal-title":"Br Heart J"},{"key":"2022072905394101100_ezac076-B11","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1136\/hrt.2010.204933","article-title":"Atrial septal defect closure is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term: a systematic review and meta-analysis","volume":"96","author":"Vecht","year":"2010","journal-title":"Heart"},{"key":"2022072905394101100_ezac076-B12","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.cjca.2011.04.003","article-title":"Atrial septal defect closure in the elderly is associated with excellent quality of life, functional improvement, and ventricular remodelling","volume":"27","author":"Hanninen","year":"2011","journal-title":"Can J Cardiol"},{"key":"2022072905394101100_ezac076-B13","doi-asserted-by":"crossref","first-page":"395","DOI":"10.4093\/dmj.2014.38.5.395","article-title":"Background and data configuration process of a nationwide population-based study using the korean national health insurance system","volume":"38","author":"Song","year":"2014","journal-title":"Diabetes Metab J"},{"key":"2022072905394101100_ezac076-B14","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1161\/CIRCULATIONAHA.117.029590","article-title":"Atrial fibrillation burden in young patients with congenital heart disease","volume":"137","author":"Mandalenakis","year":"2018","journal-title":"Circulation"},{"key":"2022072905394101100_ezac076-B15","doi-asserted-by":"crossref","first-page":"3560","DOI":"10.1093\/eurheartj\/ehx585","article-title":"Cholesterol variability and the risk of mortality, myocardial infarction, and stroke: a nationwide population-based study","volume":"38","author":"Kim","year":"2017","journal-title":"Eur Heart J"},{"key":"2022072905394101100_ezac076-B16","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s42444-019-0005-0","article-title":"Validation of diagnostic codes of major clinical outcomes in a National Health Insurance database","volume":"20","author":"Park","year":"2019","journal-title":"Int J Arrhythm"},{"key":"2022072905394101100_ezac076-B17","doi-asserted-by":"crossref","first-page":"e024344","DOI":"10.1136\/bmjopen-2018-024344","article-title":"Cohort profile: national health insurance service-senior (NHIS-senior) cohort in Korea","volume":"9","author":"Kim","year":"2019","journal-title":"BMJ Open"},{"key":"2022072905394101100_ezac076-B18","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"key":"2022072905394101100_ezac076-B19","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1038\/s41569-019-0166-5","article-title":"Postoperative atrial fibrillation: mechanisms, manifestations and management","volume":"16","author":"Dobrev","year":"2019","journal-title":"Nat Rev Cardiol"},{"key":"2022072905394101100_ezac076-B20","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1056\/NEJMoa1602002","article-title":"Rate control versus rhythm control for atrial fibrillation after cardiac surgery","volume":"374","author":"Gillinov","year":"2016","journal-title":"N Engl J Med"},{"key":"2022072905394101100_ezac076-B21","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1056\/NEJM199012133232401","article-title":"Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years","volume":"323","author":"Murphy","year":"1990","journal-title":"N Engl J Med"},{"key":"2022072905394101100_ezac076-B22","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1080\/14017430050142440","article-title":"Atrial septal defect in adults. Thirty-eight-year follow-up of a surgically and a conservatively managed group","volume":"34","author":"Thilen","year":"2000","journal-title":"Scand Cardiovasc J"},{"key":"2022072905394101100_ezac076-B23","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1093\/eurheartj\/ehq352","article-title":"Benefit of atrial septal defect closure in adults: impact of age","volume":"32","author":"Humenberger","year":"2011","journal-title":"Eur Heart J"},{"key":"2022072905394101100_ezac076-B24","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.2147\/CIA.S62313","article-title":"The benefit of atrial septal defect closure in elderly patients","volume":"9","author":"Komar","year":"2014","journal-title":"Clin Interv Ageing"},{"key":"2022072905394101100_ezac076-B25","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/0003-4975(96)00395-5","article-title":"Surgical treatment of isolated secundum atrial septal defect in patients more than 50 years old","volume":"62","author":"Shibata","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"2022072905394101100_ezac076-B26","doi-asserted-by":"crossref","first-page":"168","DOI":"10.15420\/aer.2014.3.3.168","article-title":"Pathophysiology and management of arrhythmias associated with atrial septal defect and patent foramen ovale","volume":"3","author":"Chubb","year":"2014","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"2022072905394101100_ezac076-B27","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1161\/CIRCULATIONAHA.105.592055","article-title":"Atrial septal defects in the adult: recent progress and overview","volume":"114","author":"Webb","year":"2006","journal-title":"Circulation"},{"key":"2022072905394101100_ezac076-B28","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1136\/heartjnl-2014-306552","article-title":"Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure","volume":"101","author":"Nyboe","year":"2015","journal-title":"Heart"},{"key":"2022072905394101100_ezac076-B29","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.amjcard.2007.10.035","article-title":"Predictors of atrial arrhythmias after device closure of secundum type atrial septal defects in adults","volume":"101","author":"Silversides","year":"2008","journal-title":"Am J Cardiol"},{"key":"2022072905394101100_ezac076-B30","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1056\/NEJM199903183401103","article-title":"Atrial arrhythmia after surgical closure of atrial septal defects in adults","volume":"340","author":"Gatzoulis","year":"1999","journal-title":"N Engl J Med"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/62\/2\/ezac076\/45180235\/ezac076.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/62\/2\/ezac076\/45180235\/ezac076.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T05:41:23Z","timestamp":1659073283000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezac076\/6524993"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,7,11]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezac076","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,8,1]]},"published":{"date-parts":[[2022,2,9]]},"article-number":"ezac076"}}