Surgical Repair of Acquired Ventricular Septal Defects: Outcomes and Quality of Life

Acquired ventricular septal defect (VSD), typically following myocardial infarction (MI) or infective endocarditis (IE), remains a rare but life-threatening condition. Surgical repair represents the standard of care, yet data on long-term outcomes and health-related quality of life (HRQoL) are limited.

We retrospectively analyzed 44 consecutive patients (median age 65 years, interquartile range [IQR] 57-72.5; range 20-83) who underwent surgical VSD closure at our institution between 2008 and 2023. Clinical characteristics, perioperative variables, and outcomes were assessed according to defect etiology and survival status. Long-term survival was assessed using Kaplan-Meier analysis. HRQoL among survivors was evaluated with the European Quality of Life-5-Dimensions-5-Level Version (EQ-5D-5L) questionnaire.

Post-MI VSD accounted for 65.9% of cases, and IE-related VSD for 20.5%. Preoperative cardiogenic shock was present in 52.3%. Overall, 30-day mortality was 34.1% (MI-VSD 46.4%, IE-VSD 22.2%). Non-survivors were older (69.2 vs. 60.8 years, p = 0.015), more frequently in shock (80.0% vs. 37.9%, p = 0.013), and experienced more postoperative complications per patient (1.9 vs. 0.4, p = 0.001). Median follow-up among survivors was 10.7 years (IQR 6.6-13.8; range 2.0-17.2). Kaplan-Meier survival at 2 and 5 years was 61.4% and 56.8%, respectively. HRQoL was generally preserved, with favorable mental and social domain scores (e.g., anxiety/depression: mean 1.6/5) and acceptable physical functioning (e.g., pain/discomfort: mean 1.9/5). Younger age at repair and longer follow-up were associated with higher HRQoL.

Despite substantial perioperative mortality-particularly in post-MI VSD and hemodynamically unstable patients-surgical closure provides durable long-term survival with overall satisfactory HRQoL in survivors.