Indications and Outcomes of Surgical Closure of Ventricular Septal Defect in Adults

Objectives: We sought to review our experience with surgical ventricular septal defect (VSD) closure in adults. Background: Outcome data of VSD closure in adults on which to base recommendations are limited. Guidelines recommend closure of adult VSD for a Q_p/Q_s ratio ≥2, left ventricular volume overload, or endocarditis. Methods: We retrospectively reviewed 46 patients (mean age 33.6 ± 11.2 years, 24 women) who underwent surgical VSD closure (1958 to 2008). Results: VSDs were classified according to the Society of Thoracic Surgeons as type 2 (membranous, 72%) or type 1 (subarterial, 26%). Aortic regurgitation (AR) (28%), left ventricular dilation (20%), and pulmonary hypertension (20%) were the most common indications for closure. Associated lesions justified surgery in 39% of patients. There were no early deaths. Morbidity included 1 high-grade atrioventricular block requiring permanent pacemaker and a residual VSD in 7 patients. Late mortality was 5% (mean follow-up: 10.3 ± 12.4 years). Patient survival did not differ from expected survival in a reference population (p = 0.75). Late residual VSDs were more common after suture closure (6 of 8 patients). Late moderate AR developed in 5 patients (4 with a type 1 VSD) with aortic valve or sinus of Valsalva repair. The use of intraoperative transesophageal echocardiography was associated with fewer residual VSDs and less ≥ moderate tricuspid valve regurgitation and AR. Conclusions: Associated heart defects and AR were common indications for VSD closure in adults, which was performed with low mortality and morbidity. Patch closure and use of intraoperative transesophageal echocardiography improve surgical outcomes. Important residua emphasize the need for life-long informed follow-up.