Key result
Preoperative mild AR linked to ~60-fold higher risk of surgical aortic regurgitation after transcatheter VSD closure.
Why the study?
The incidence and risk factors for aortic regurgitation requiring unplanned surgery after transcatheter closure of ventricular septal defect in children needed investigation.
What are the incidence and anatomical/clinical risk factors for new-onset or worsening aortic regurgitation requiring unplanned surgery in children undergoing transcatheter closure of ventricular septal defect?
Cohort (n=876)
No
What are the incidence and anatomical/clinical risk factors for new-onset or worsening aortic regurgitation requiring unplanned surgery in children undergoing transcatheter closure of ventricular septal defect?
Identifies preoperative mild AR, intracristal VSD location, larger defect-to-BSA ratio, and a sub-aortic rim <2 mm as critical predictors of acute aortic regurgitation requiring unplanned surgical conversion during pediatric transcatheter VSD closure.
Answers are grounded in this paper and cite their sources.
May guide selection for pediatric transcatheter VSD closure; leaves open prospective validation of risk thresholds.
INTRODUCTION: Our aim was to investigate the incidence and risk factors for aortic regurgitation (AR) requiring unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children. METHODS: Medical records of 876 children with VSD who underwent transcatheter closure from July 2009 to September 2018 in our hospital were retrospectively reviewed. Groups with and without new-onset or increasing AR requiring unplanned surgery were compared. Univariate and multivariate analyses were used to identify the possible risk factors. Smoothing plot and threshold effect analysis were carried out to find the relationship between possible factors and risk of new-onset or increasing AR. RESULTS: A total of 29 children (3.3%) underwent unplanned surgery after transcatheter closure owing to new-onset or increasing AR, including 6 children with new-onset AR and 23 children with increasing AR. Multivariate regression analysis revealed that preoperative mild AR (OR: 60.39, 95% CI: 11.53-316.30, p < 0.001), larger ratio between diameter to body surface area (OR: 1.25, 95% CI: 1.01-1.55, p = 0.039), intracristal VSD (OR: 34.09, 95% CI: 4.07-285.65, p < 0.001), and shorter distance from the upper edge of defect to the aortic valve (or the sub-aortic rim) (OR: 0.12, 95% CI: 0.05-0.27, p < 0.001) were risk factors for new-onset or increasing AR requiring unplanned surgery. And, low risk of AR after muscular VSD transcatheter closure was found. An L-shaped nonlinear relationship between the sub-aortic rim and the risk of new-onset or increasing AR was observed, and the risk of new-onset or increasing AR with the sub-aortic rim up to the turning point (2 mm) (adjusted OR: 0.00, 95% CI: 0.00-0.08; p =0.001). With a median time of 7.3 years' follow-up, no new-onset or increasing AR has been found for children who initially did not have unplanned surgery. CONCLUSION: Preoperative mild AR, larger ratio between diameter to body surface area, intracristal VSD, and shorter distance of the sub-aortic rim (especially <2 mm) could increase the risk of new-onset or increasing AR requiring unplanned surgery after transcatheter closure of VSD.
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Zhang et al. (2022) conducted a cohort in Ventricular septal defect (VSD) undergoing transcatheter closure (n=876). Preoperative mild aortic regurgitation (in children undergoing transcatheter VSD closure) vs. No preoperative mild aortic regurgitation was evaluated on New-onset or increasing aortic regurgitation (AR) requiring unplanned surgery after transcatheter VSD closure (OR 60.39, 95% CI 11.53-316.30, p=<0.001). Transcatheter VSD closure in children resulted in a 3.3% incidence of aortic regurgitation requiring unplanned surgery, strongly driven by preoperative mild AR and sub-aortic rim <2 mm.
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