Device closure versus surgical repair for doubly committed subarterial ventricular septal defect

Device closure for doubly committed subarterial ventricular septal defect has been applied in the past decade. However, studies on this issue are largely small-sample, single-arm studies, with inconsistent outcomes. This study aimed to demonstrate that device closure and surgical repair could achieve similar midterm results for patients with doubly committed subarterial ventricular septal defect.

This was a single-center, retrospective comparative study. The primary end point was a hierarchical composite comprising new-onset aortic regurgitation during follow-up, residual shunt at the last follow-up, and cardiovascular event-related or procedure-related readmission within 4 weeks after discharge.

From 2013 to 2023, 553 patients with doubly committed subarterial ventricular septal defect were included. There were 244 patients in the device closure group and 309 patients in the surgical repair group; the procedural success rates were 97.1% and 100.0% for each group, respectively (P = .003). The overall median follow-up time was 48.0 (18.0-76.0) months. Regarding our primary end point, the win ratio comparing device closure with surgical repair was 1.11 (95% CI, 0.63-1.98, P = .716). The risk of new-onset aortic regurgitation was similar between the 2 groups (5.5% vs 4.0%; log-rank P = .474). Residual shunt rates at the last follow-up and 4-week readmission rates were also comparable (3.0% vs 3.6%, P = .664; and 0.8% vs 2.3%, P = .326).

According to our retrospective data, device closure for doubly committed subarterial ventricular septal defect had both a satisfactory success rate and a low incidence of postoperative adverse events. During the midterm follow-up, results for our primary end point were comparable between device closure and surgical repair.