Outflow Ventricular Septal Defect With Aortic Regurgitation: Optimal Timing of Surgery?

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The optimal surgical timing for outflow ventricular septal defect (VSD) with aortic regurgitation (AR) remains debated.
• Identifying predictors of postoperative AR progression is crucial for patient management.

Purpose of the Study:

• To determine the prevalence and predictors of AR progression after VSD surgery in patients with concomitant AR.
• To evaluate the impact of preoperative AR severity and VSD location on AR progression.

Main Methods:

• Retrospective study of 154 patients with outflow VSD and AR who underwent VSD surgery (2006-2012).
• Patients were categorized by VSD location (subpulmonic vs. subaortic) and preoperative AR severity (trivial/mild vs. moderate/severe).
• Follow-up averaged 6.32 years to assess AR progression and need for aortic valve replacement (AVR).

Main Results:

• AR grade worsened significantly in moderate/severe preoperative AR patients with subaortic VSD (P=.005).
• 42.6% of moderate/severe AR patients required AVR, all with subaortic VSD and prior valvuloplasty.
• 10-year freedom from moderate/severe AR was significantly lower in moderate/severe AR groups, particularly with subaortic VSD (42.5%) compared to subpulmonic VSD (66.7%).

Conclusions:

• Mild preoperative AR rarely progresses post-VSD repair.
• Worsening AR, even with valvuloplasty, is difficult to prevent once moderate/severe AR develops.
• Postoperative residual AR is the primary predictor of AR progression, necessitating close monitoring, especially in subaortic VSD.