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Multivariate analysis revealed that surgical closure of the defect significantly reduced mortality from all causes(relative risk,0.31;95 percent confidence interval,0.11 to 0.85).The adjusted 10-year survival rate of surgically treated patients was 95 percent,as compared with 84 percent for the medically treated patients.In addition,surgical treatment prevented functional deterioration,as measured by the New York Heart Association class(relative risk,0.21;95 percent confidence interval,0.08 to 0.55).However,the incidence of new atrial arrhythmias or of cerebrovascular insults in the two groups was not significantly different. The surgical repair of an atrial septal defect in patients over 40 years of age,as compared with medical therapy,increases long-term survival and limits the deterioration of function due to heart failure.However, surgically treated patients should be followed closely for the onset of atrial arrhythmias so as to reduce the risk of thromboembolic complications. |
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