Abstract 13663: The Unnatural History of the Ventricular Septal Defect: Outcome up to 40 Years after Surgical Closure
Introduction: Prospective data on long term outcome after ventricular septal defect (VSD) closure do not exist.
Objectives: To evaluate survival and clinical outcome in a prospectively followed patient cohort up to 40 years after surgical VSD closure.
Methods: A cohort of 174 consecutive patients who had surgical VSD repair at young age between 1968-1980, is investigated every 10 years. The study protocol comprised echocardiography, ergometry, Holter monitoring, NT-proBNP, and SF-36 questionnaire.
Results: Survival status was obtained in 90% of 174 patients, and 84% of the eligible survivors participated in the in-hospital examination after median follow-up of 36 (range 30-40) years. A simple concomitant cardiac lesion (non-isolated VSD) was present in 32%. Postoperative mortality within 30 days was 10%, and late mortality at 40 years was 14%. Eight patients died in the last decade: 3 cardiac (arrhythmia n=2, heart failure n=1), 3 non-cardiac, and 2 unknown causes. Cumulative event incidence at 40 years was 38%, including interventions in 13%, symptomatic arrhythmias in 11%, and pacemaker/ICD in 7%. Most events occurred in non-isolated VSD patients (Fig. 1). LV systolic function was impaired in 21%, but remained stable over the last decade. Prevalence of RV systolic dysfunction increased from 1% to 16% (p=0.001). Mean workload decreased from 91% to 87% of expected (p=0.01). NT-proBNP (median 11.6 [IQR 7.0-19.8] pmol/L) was elevated in 38%. Postoperative complete atrioventricular block and non-isolated VSD were predictive for late events (HR 3.9 [95%CI 1.2-13.0]; HR 3.5 [95%CI 1.7-7.2]). Regarding the SF-36, patients scored their health status significantly better than the reference population.
Conclusions: Survival up to 40 years after successful surgical VSD closure is slightly lower than in the general Dutch population. Although many patients are discharged from routine follow-up, morbidity is substantial, especially in patients with non-isolated VSD.
Author Disclosures: M.E. Menting: None. J.A. Cuypers: None. P. Opic: None. E.M. Utens: None. W.A. Helbing: None. M. Witsenburg: None. A.E. van den Bosch: None. R.T. van Domburg: None. F.J. Meijboom: None. A.J. Bogers: None. J.W. Roos-Hesselink: None.
- © 2014 by American Heart Association, Inc.