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Long-term results of aortic valvuloplasty for aortic regurgitation associated with ventricular septal defect
1Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
Insights
Long-term aortic valvuloplasty for aortic regurgitation with ventricular septal defect shows high survival rates. However, valvuloplasty failure occurred in 17 patients, with older age and specific VSD types being risk factors.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Aortic regurgitation associated with ventricular septal defect (VSD) requires surgical intervention.
- Aortic valvuloplasty is a potential treatment option for this complex condition.
Purpose of the Study:
- To present long-term results of aortic valvuloplasty in patients with VSD.
- To identify factors associated with valvuloplasty failure and reoperation.
Main Methods:
- Retrospective analysis of 64 patients undergoing aortic valvuloplasty for VSD.
- Assessment of operative data, long-term follow-up, and reoperation rates.
- Statistical analysis including multiple regression to identify risk factors.
Main Results:
- One operative death (1.6%) and no late deaths; 15-year actuarial survival rate of 98.3%.
- Valvuloplasty failure occurred in 17 patients, with 15-year freedom from failure at 55.3%.
- Eight patients required reoperation for residual aortic regurgitation, with 15-year freedom from reoperation at 63.7%.
Conclusions:
- Aortic valvuloplasty offers excellent long-term survival for VSD-associated aortic regurgitation.
- Older age, higher cardiothoracic ratio, perimembranous VSD, and multiple valvuloplasties are associated with poorer outcomes.
- Careful patient selection and surgical technique are crucial for optimizing results.
Abstract:
Long-term results in 64 patients who underwent aortic valvuloplasty for aortic regurgitation associated with ventricular septal defect are presented. The average age of the patients was 10.2 years and the average cardiothoracic ratio was 0.57 at the time of operation. The average degree of aortic regurgitation, as classified by Sellers, was 2.7. The type of ventricular septal defect was subpulmonic in 31 patients, perimembranous in 20, and was a total conal defect in five patients. Valvuloplasty was performed at one end of an aortic cusp in 23 patients, at two ends in 33, at three ends in six, and at four ends in two patients. There was one operative death (1.6%). The follow-up period was 447.7 patient-years, and there were no late deaths. The actuarial survival rate was 98.3% at 5, 10, and 15 years. Postoperative cardiac catheterization was performed in 40 patients. Valvuloplasty failure was defined as the presence of a cardiothoracic ratio greater than 0.6, a loud regurgitant murmur (Levine grade 3/6 or greater), moderate or severe aortic regurgitation (Sellers grade 3 or 4), or the necessity of reoperation. There were 17 patients whose valvuloplasty failed. The freedom from valvuloplasty failure was 74.2% at 5 and 10 years and 55.3% at 15 years. Eight patients underwent reoperation because of residual aortic regurgitation, and all survived. The freedom from reoperation was 90.1% at 5 years, 80.5% at 10 years, and 63.7% at 15 years. Multiple regression analysis revealed that older age, a greater cardiothoracic ratio, perimembranous ventricular septal defect, and multiple valvuloplasties were significant contributing factors for residual regurgitation after aortic valvuloplasty.