Long-term outcome after surgical ventricular septal defect closure: Longitudinal follow-up into the fifth decade

TL;DR

This study tracks patients who had heart surgery for a ventricular septal defect into their 40s and finds that most have good long-term quality of life despite some complications.

Contribution

The study provides the longest follow-up to date on patients with surgically closed ventricular septal defects, reaching into the fifth decade of life.

Findings

Event-free survival at 49 years was 50%, with arrhythmias, pacemaker implantation, and VSD-related interventions as common complications.

Quality of life remained stable and comparable to the general population despite mild reductions in exercise capacity.

Early postoperative arrhythmias were a predictor of long-term mortality.

Abstract

To evaluate survival, clinical outcome and quality of life (QoL) of patients up to 49 years after surgical ventricular septal defect (VSD) closure.

Single-center, longitudinal cohort study evaluating consecutive patients with surgical VSD closure between 1968 and 1980 with extensive cardiac and QoL evaluation every decade.

Of the original cohort of 174 patients, 39 died (22 %), 8 were lost to follow-up and 38 had not participated previously. Survival rate at 49 years follow-up was 77 % and 86 % when excluding early postoperative mortality. Of the 89 eligible survivors, 76 (85 %) were evaluated (59 % male, median age 49 [44–54] years) with a median follow-up of 44 (range 40–49) years after surgery. Event-free survival at 49 years was 50 %, with symptomatic arrhythmias (10 %), pacemaker implantation (8 %) and VSD-related interventions (3 %) being common complications. At last follow-up, 58 % had left atrial dilation, 25 % had aortic regurgitation and 5 patients (7 %) had a residual VSD. Early postoperative arrhythmias predicted mortality. Both left ventricular (LV) and right ventricular ejection fraction remained stable, with only 1 % having an LV ejection fraction below 45 % at last follow-up. Exercise capacity and VO2max were mildly reduced in 33 % and 49 % of the patients while self-perceived QoL was stable and comparable with the general Dutch population.

Half of the patients with surgical VSD closure had an event-free survival at 49 years. Pacemaker implantation was often needed. Early postoperative arrhythmias predicted mortality. QoL was good and remained stable over time.

This central illustration summarizes the long-term follow-up of patients who underwent surgical ventricular septal defect (VSD) closure during childhood. Survival at 49 years was 77 %. Event-free survival was 50 %, with arrhythmias (10 %), pacemaker implantation (8 %), and VSD-related interventions (3 %) as the most frequent complications. PR and QRS prolongation, left atrial dilation and aortic regurgitation were common. Early postoperative arrhythmias predicted mortality. Despite these findings, ventricular function was largely preserved and exercise capacity only mildly reduced. Importantly, self-reported quality of life was stable and comparable to the general population, highlighting favorable long-term functional outcomes in this aging cohort.Image 1

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