A Systematic Review and Meta-Analysis of the Valvular Insufficiency Status after Surgical Closure of Ventricular Septal Defects

Objective: This article aims to provide a reference for assessing surgical safety by comparing postoperative outcomes of various degrees of valve insufficiency associated with different surgical approaches after ventricular septal defect (VSD) repair. Methods: We conducted a database search using the following methods: querying the PubMed database through National Center for Biotechnology Information (NCBI), querying the Embase database through Ovid, and querying the Web of Science database. This article focused on comparing the improvement in aortic regurgitation (AR), analyzing the incidence of tricuspid regurgitation (TR) following exposure of the VSD through a right atrial approach using tricuspid valve detachment (TVD) or conventional exposure (non-TVD), and pulmonary regurgitation (PR) via a pulmonary artery approach. Results: AR was included in nine studies, involving 329 children with VSDs. The combined improvement rate of AR across these studies was approximately 0.487 (I2 = 50.3%; p = 0.041). The proportion of patients who underwent aortic valve repair or replacement (p = 0.029) and the preoperative severity of AR ≥ moderate (p = 0.007) may have contributed to heterogeneity. There were 245 cases in the isolated VSD repair group, while the remaining 84 cases underwent combined aortic valve repair or replacement. There was a significant difference in the improvement rate of AR between the two groups during follow-up (I2 = 63.3%, Relative Risk (RR) = 0.51, 95% CI = 0.34–0.76, p = 0.005). RR: The ratio of the probability of the outcome event occurring in the exposed group to the probability of the outcome event occurring in the unexposed group. A total of 12 studies were related to TR and residual shunting. A total of 1338 children with VSD were included in 10 studies of TR, where the TVD group had 599 cases and the non-TVD group had 739 cases. No significant difference was noted in the rates of TR ≥ mild between these groups during the follow-up (I2 = 14.4%, RR = 1, 95% CI = 0.82–1.21; p = 0.311). Additionally, no significant difference existed in the residual shunting rate through the ventricular septum during follow-up (I2 = 0.0%, RR = 0.72, 95% CI = 0.37–1.40; p = 0.785). A total of 285 children were included in three studies on PR, with a combined rate of PR during follow-up of 23.0% (I2 = 46.567%; p = 0.154). Conclusion: The improvement rate of AR during follow-up was lower in the isolated VSD-repair group compared to the group undergoing concomitant aortic valve repair or replacement. The proportion of preoperative AR ≥ moderate showed a positive correlation with the improvement rate of AR, whereas the percentage of isolated VSD repairs exhibited a negative correlation with AR. Additionally, the TR status during follow-up was similar between the TVD and non-TVD groups for VSD repair. Furthermore, patients who underwent VSD repair via the pulmonary artery approach had a higher incidence of PR in the long term. The PROSPERO Registration: CRD42025630254 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42025630254).