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Long-Term Outcomes of Surgical Repair for Ventricular Septal Defect in Adults

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Abstract

Data of the outcomes of ventricular septal defect (VSD) closure in adults are limited to establish recommendations. Therefore, we reviewed our experience with surgical VSD closure in adult patients. We retrospectively reviewed 152 patients who underwent surgical VSD closure between January 1996 and April 2020. The median age of the patients was 30.5 [interquartile range (IQR) 23.1–42.7] years. The median follow-up duration was 10.9 (IQR 4.8–16.1) years. VSDs were classified according to the Society of Thoracic Surgeons classification as type 2 (n = 66, 43.4%), type 1 (n = 59, 38.8%), and type 4 (n = 27, 17.8%). Aortic cusp prolapse (n = 86, 56.6%) and aortic valve regurgitation (AR, n = 75, 49.3%) were the most common indications for surgical closure. Four patients underwent late reoperation (2.6%) due to AR, infective endocarditis and residual VSD. In the log-rank test, preoperative trivial or more degree of AR (P = 0.004) and coronary cusp deformity (P = 0.031) was associated with late moderate or greater degree of AR. Preoperative moderate or greater AR was associated with reoperation (P = 0.047). Only concomitant aortic valve (AV) repair at the time of VSD closure was a significant risk factor for late significant AR progression in the multivariable analysis. VSD closure in adults can be performed with low mortality and morbidity rates. AR can progress after VSD closure because the aortic cusp may have irreversible damage from long-standing shunt flow exposure. We conclude that VSD with AV deformity or AR in adults should be treated aggressively before disease progression with irreversible damage occurs.

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References

  1. Mongeon FP, Burkhart HM, Ammash NM, Dearani JA, Li Z, Warnes CA, Connolly HM (2010) Indications and outcomes of surgical closure of ventricular septal defect in adults. JACC Cardiovasc Interv 3:290–297. https://doi.org/10.1016/j.jcin.2009.12.007

    Article  PubMed  Google Scholar 

  2. Meijboom F, Szatmari A, Utens E, Deckers JW, Roelandt JR, Bos E, Hess J (1994) Long-term follow-up after surgical closure of ventricular septal defect in infancy and childhood. J Am Coll Cardiol 24:1358–1364. https://doi.org/10.1016/0735-1097(94)90120-1

    Article  CAS  PubMed  Google Scholar 

  3. van Rijen EH, Utens EM, Roos-Hesselink JW, Meijboom FJ, van Domburg RT, Roelandt JR, Bogers AJ, Verhulst FC (2003) Psychosocial functioning of the adult with congenital heart disease: a 20–33 years follow-up. Eur Heart J 24:673–683. https://doi.org/10.1016/s0195-668x(02)00749-2

    Article  PubMed  Google Scholar 

  4. Neumayer U, Stone S, Somerville J (1998) Small ventricular septal defects in adults. Eur Heart J 19:1573–1582. https://doi.org/10.1053/euhj.1998.1083

    Article  CAS  PubMed  Google Scholar 

  5. Kidd L, Driscoll DJ, Gersony WM, Hayes CJ, Keane JF, O’Fallon WM, Pieroni DR, Wolfe RR, Weidman WH (1993) Second natural history study of congenital heart defects. Results of treatment of patients with ventricular septal defects. Circulation 87:I38–I51

    Article  CAS  Google Scholar 

  6. Gabriel HM, Heger M, Innerhofer P, Zehetgruber M, Mundigler G, Wimmer M, Maurer G, Baumgartner H (2002) Long-term outcome of patients with ventricular septal defect considered not to require surgical closure during childhood. J Am Coll Cardiol 39:1066–1071. https://doi.org/10.1016/s0735-1097(02)01706-0

    Article  PubMed  Google Scholar 

  7. Mattila S, Kostiainen S, Kyllonen KE, Tala P (1985) Repair of ventricular septal defect in adults. Scand J Thorac Cardiovasc Surg 19:29–31. https://doi.org/10.3109/14017438509102817

    Article  CAS  PubMed  Google Scholar 

  8. Bol Raap G, Meijboom FJ, Kappetein AP, Galema TW, Yap SC, Bogers AJ (2007) Long-term follow-up and quality of life after closure of ventricular septal defect in adults. Eur J Cardiothorac Surg 32:215–219. https://doi.org/10.1016/j.ejcts.2007.04.023

    Article  PubMed  Google Scholar 

  9. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF (2019) 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. Circulation 139:e698–e800. https://doi.org/10.1161/CIR.0000000000000603

    Article  PubMed  Google Scholar 

  10. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802. https://doi.org/10.1016/S0894-7317(03)00335-3

    Article  PubMed  Google Scholar 

  11. Otterstad JE, Froysaker T, Erikssen J, Simonsen S (1985) Long-term results in isolated ventricular septal defect surgically repaired after age 10. Comparison with the natural course in similarly-aged patients. Scand J Thorac Cardiovasc Surg 19:221–229. https://doi.org/10.3109/14017438509102723

    Article  CAS  PubMed  Google Scholar 

  12. van Son JA, Danielson GK, Schaff HV, Orszulak TA, Edwards WD, Seward JB (1994) Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm. Circulation 90:II20–II29

    PubMed  Google Scholar 

  13. Cheung YF, Chiu CS, Yung TC, Chau AK (2002) Impact of preoperative aortic cusp prolapse on long-term outcome after surgical closure of subarterial ventricular septal defect. Ann Thorac Surg 73:622–627. https://doi.org/10.1016/s0003-4975(01)03393-8

    Article  PubMed  Google Scholar 

  14. Chiu SN, Wang JK, Lin MT, Chen CA, Chen HC, Chang CI, Chen YS, Chiu IS, Lue HC, Wu MH (2007) Progression of aortic regurgitation after surgical repair of outlet-type ventricular septal defects. Am Heart J 153:336–342. https://doi.org/10.1016/j.ahj.2006.10.025

    Article  PubMed  Google Scholar 

  15. Amano M, Izumi C, Imamura S, Onishi N, Tamaki Y, Enomoto S, Miyake M, Tamura T, Kondo H, Kaitani K, Yamanaka K, Nakagawa Y (2016) Progression of aortic regurgitation after subpulmonic infundibular ventricular septal defect repair. Heart 102:1479–1484. https://doi.org/10.1136/heartjnl-2015-309005

    Article  PubMed  Google Scholar 

  16. Tweddell JS, Pelech AN, Frommelt PC (2006) Ventricular septal defect and aortic valve regurgitation: pathophysiology and indications for surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. https://doi.org/10.1053/j.pcsu.2006.02.020

    Article  PubMed  Google Scholar 

  17. Brizard C (2006) Surgical repair of infundibular ventricular septal defect and aortic regurgitation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. https://doi.org/10.1053/j.pcsu.2006.02.021

    Article  PubMed  Google Scholar 

  18. Elgamal MA, Hakimi M, Lyons JM, Walters HL III (1999) Risk factors for failure of aortic valvuloplasty in aortic insufficiency with ventricular septal defect. Ann Thorac Surg 68:1350–1355. https://doi.org/10.1016/s0003-4975(99)00970-4

    Article  CAS  PubMed  Google Scholar 

  19. Giordano R, Cantinotti M, Di Tommaso L, Comentale G, Tozzi A, Pilato E, Iannelli G, Palma G (2018) The fate of the tricuspid valve after the transatrial closure of the ventricular septal defect. Ann Thorac Surg 106:1229–1233. https://doi.org/10.1016/j.athoracsur.2018.04.054

    Article  PubMed  Google Scholar 

  20. Fraser CD III, Zhou X, Palepu S, Lui C, Suarez-Pierre A, Crawford TC, Magruder JT, Jacobs ML, Cameron DE, Hibino N, Vricella LA (2018) Tricuspid valve detachment in ventricular septal defect closure does not impact valve function. Ann Thorac Surg 106:145–150. https://doi.org/10.1016/j.athoracsur.2018.02.075

    Article  PubMed  Google Scholar 

  21. Bang JH, Park CS, Park JJ, Yun TJ, Baek JS, Yu JJ, Kim YH, Ko JK (2016) Detachment of the tricuspid valve for ventricular septal defect closure in infants younger than 3 months. J Thorac Cardiovasc Surg 152:491–496. https://doi.org/10.1016/j.jtcvs.2016.03.067

    Article  PubMed  Google Scholar 

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Acknowledgements

Statistical analysis was supported by the Seoul National University Hospital Medical Research Collaborating Center.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, South Korea

    Jae Hong Lim, Chang-Ha Lee, Eung Re Kim & Yong Jin Kim

  2. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea

    Sungkyu Cho

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Correspondence to Sungkyu Cho.

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This study was approved by the Institutional Review Board of Sejong General Hospital (2020-0537).

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This article was presented at the 34th Annual Meeting of the European Association for Cardio-Thoracic Surgery, October 8–10, 2020.

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Lim, J.H., Cho, S., Lee, CH. et al. Long-Term Outcomes of Surgical Repair for Ventricular Septal Defect in Adults. Pediatr Cardiol 43, 1277–1285 (2022). https://doi.org/10.1007/s00246-022-02849-5

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