• Ann. Thorac. Surg. · Jun 2021

    Outflow Ventricular Septal Defect with Aortic Regurgitation: Optimal timing of Surgery?

    • Priya Giridhara, Amitabh Poonia, Deepa S Kumar, Kavassery M Krishnamoorthy, Sivasankaran Sivasubramonian, and Ajitkumar Valaparambil.
    • Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India-695011.
    • Ann. Thorac. Surg. 2021 Jun 26.

    BackgroundIdeal time of surgery still remains controversial in outflow ventricular septal defect (VSD) with aortic regurgitation (AR). We aimed to identify the prevalence and predictors of postoperative AR progression.Methods154 patients with outflow-VSD and AR who underwent VSD surgery between 2006 and 2012 were studied retrospectively.ResultsTotal 80 patients with subpulmonic-VSD and 74 with subaortic-VSD were followed-up for mean 6.32+/-2.27 years (range 3-12 years). Of them, 100 had trivial to mild (group-A) and 54 had moderate to severe preoperative-AR (group-B). At follow-up, There was no significant worsening of mean residual AR in group-A (p=0.16) and subpulmonic-VSD of group-B (p=0.083). However, it worsened significantly in subaortic-VSD (1.85+/-0.87 vs 2.21+/-1.08, p=0.005) of group-B. Only 2 (both had subaortic-VSD) patients of group-A developed moderate AR and none required aortic valve replacement (AVR), while 23 (42.60%) of group-B patients developed moderate or severe AR and 7 (30.4%) of them required AVR. Moreover, all who needed AVR had subaortic-VSD and had undergone valvuloplasty during VSD-closure. The 10 years freedom from moderate or severe-AR was significantly lower in group-B than group-A in both VSDs (subaortic-VSD 42.5+/-10.7% vs 89.3+/-8.1%, p<0.01; subpulmonic-VSD 66.7+/-10.3% vs 100%, p<0.01). On multiple regression analysis, postoperative residual-AR was the only predictor of AR-progression (standardized coefficients =0.48; p<0.001) at follow-up.ConclusionsMild preoperative-AR rarely progressed after VSD-repair. However, worsening of AR could not be prevented effectively, even with valvuloplasty, after the development of moderate or severe AR. Mild or more postoperative residual-AR need close follow-up, especially in subaortic-VSD.Copyright © 2021. Published by Elsevier Inc.

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