Abstract Objectives To evaluate survival, clinical outcome and quality of life (QoL) of patients with ventricular septal defect (VSD) up to 49 years after surgical closure at young age. Methods Single center, longitudinal cohort study evaluating consecutive patients with VSD who underwent surgical closure between 1968 and 1980 with extensive cardiac and psychological evaluation every decade. Results Of the original cohort of 174 patients, 39 died (22%), 16 of them early postoperatively (first 30 days after surgery) mainly due to low cardiac output syndrome or cardiac arrest. The remaining deaths were due to sudden cardiac death (n=4), malignancies (n=4), infections (n=3), or other/unknown causes (n=12). Among hospital survivors, 73% were alive after 49 years. Of the 89 eligible survivors, 76 (85%) were evaluated (59% male, median age 49 years) with a median follow-up of 44 (range 40-49) years after surgery. The event-free survival rate was 50% with symptomatic arrhythmias (10%), pacemaker implantation (8%) and VSD-related interventions (3%) being common complications. At last follow-up, 59% of the patients had left atrial dilation, 25% had mild aortic regurgitation and 5 patients had a residual VSD. One patient experienced an out-of-hospital cardiac arrest based on ventricular tachycardia and received an ICD implantation, while 5% had non-sustained ventricular tachycardia on the 24-hour Holter measurement. Predictor analyses revealed that early postoperative arrhythmias predicted mortality. Both left and right ventricular ejection fraction remained stable over time, with only 1% of the patients having an ejection fraction below 45%. Exercise capacity and VO2max were (mildly) reduced in 33% and 49% of the patients. Lastly, the VSD patients reported a good and stable self-perceived QoL, comparable with the general Dutch population. Conclusion Mortality and morbidity in this cohort of surgical VSD closure were significant, with an event-free survival of 50% at 49 years. Pacemaker implantation was often needed, not only postoperatively but also throughout life. Early postoperative arrhythmias predicted mortality. Quality of life was good and remained stable over time.
Ünlütürk et al. (Sat,) studied this question.