Author + information
- Received September 30, 2014
- Revision received February 23, 2015
- Accepted February 24, 2015
- Published online May 12, 2015.
- Myrthe E. Menting, MD∗,
- Judith A.A.E. Cuypers, MD∗,
- Petra Opić, MSc∗,
- Elisabeth M.W.J. Utens, PhD†,
- Maarten Witsenburg, MD, PhD∗,
- Annemien E. van den Bosch, MD, PhD∗,
- Ron T. van Domburg, PhD∗,
- Folkert J. Meijboom, MD, PhD‡,
- Eric Boersma, PhD∗,
- Ad J.J.C. Bogers, MD, PhD§ and
- Jolien W. Roos-Hesselink, MD, PhD∗∗ ()
- ∗Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
- †Department of Child and Adolescent Psychiatry and Psychology, Sophia Children’s Hospital, Rotterdam, the Netherlands
- ‡Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- §Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Jolien W. Roos–Hesselink, Erasmus University Medical Center, Department of Cardiology, Room Ba-583a, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
Background Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD).
Objectives The objective of this study was to investigate clinical outcomes >30 years after surgical VSD closure.
Methods Patients who underwent surgical VSD closure during childhood between 1968 and 1980 were reexamined every 10 years. In 2012, we invited eligible patients to undergo another examination, which included electrocardiography, Holter monitoring, echocardiography, bicycle ergometry, measurement of N-terminal pro–B-type natriuretic peptide, and subjective health assessment.
Results Cumulative survival was 86% at 40 years. Causes of mortality were arrhythmia, heart failure, endocarditis, during valvular surgery, pulmonary hypertension, noncardiac causes, and unknown causes. Cumulative event-free survival after surgery was 72% at 40 years. Symptomatic arrhythmias occurred in 13% of patients and surgical or catheter-based reinterventions in 12%. Prevalence of impaired right ventricular systolic function increased from 1% in 2001 to 17% in 2012 (p = 0.001). Left ventricular systolic function was impaired but stable in 21% of patients. Aortic regurgitation occurred more often in the last 20 years (p = 0.039), and mean exercise capacity decreased (p = 0.003). N-terminal pro–B-type natriuretic peptide (median: 11.6 pmol/l [interquartile range: 7.0 to 19.8 pmol/l]) was elevated (>14 pmol/l) in 38% of patients. A concomitant cardiac lesion, for example, patent ductus arteriosus, and aortic cross-clamp time were determinants of late events (hazard ratio: 2.84 [95% confidence interval: 1.23 to 6.53] and hazard ratio: 1.47 per 10 min [95% confidence interval: 1.22 to 1.99], respectively). Patients rated their subjective health status significantly better than a reference population.
Conclusions Survival up to 40 years after successful surgical VSD closure is slightly lower than in the general Dutch population. Morbidity is not negligible, especially in patients with a concomitant cardiac lesion.
This study was supported by a grant from the Dutch Heart Foundation (grant number 2009-B-073). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 30, 2014.
- Revision received February 23, 2015.
- Accepted February 24, 2015.
- American College of Cardiology Foundation