Key result
Transcatheter VSD closure with KONAR-MF achieves ~95% success, with RCC prolapse predicting procedural failure.
Why the study?
Transcatheter closure of VSD is a promising alternative to surgery, but outcomes in patients with coexisting aortic valve prolapse remain limited.
What are the outcomes and risk factors for procedural failure and aortic regurgitation progression after transcatheter VSD closure using the KONAR-MF Occluder in patients with aortic valve prolapse?
Cohort (n=109)
No
What are the outcomes and risk factors for procedural failure and aortic regurgitation progression after transcatheter VSD closure using the KONAR-MF Occluder in patients with aortic valve prolapse?
Transcatheter VSD closure using the KONAR-MF Occluder is highly successful, but significant right coronary cusp prolapse predicts procedural failure and device clamping of the aortic cusp increases the risk of long-term aortic regurgitation progression.
May inform risk stratification before KONAR-MF VSD closure; leaves open prospective validation of prolapse index and clamping technique.
BACKGROUND: Transcatheter closure of ventricular septal defect (VSD) is a promising alternative to surgery; however, outcomes in patients with coexisting aortic valve prolapse (AVP) remain limited. OBJECTIVES: The authors aimed to evaluate outcomes and risk factors after VSD closure using the KONAR-MF Occluder (MFO) in a large Asian cohort with a high prevalence of AVP. METHODS: Between 2021 and 2024, consecutive patients undergoing transcatheter VSD closure at our institution using only the MFO were enrolled. Right coronary cusp (RCC) prolapse was quantified using the RCC prolapse index on transesophageal echocardiography. Device position relative to the aortic cusp was classified as nontouching, clamping, or holding. Risk factors for procedural failure and progression of aortic regurgitation (AR) were analyzed. RESULTS: Among 109 cases (13.8%, 15 of 109 doubly committed [Dc] type), 61.5% (67 of 109) had AVP. The procedural success rate was 94.5% (103 of 109; 95% CI: 88.4%-98.0%). Younger age, Dc VSD, aortic rim deficiency, and larger defect size were univariate correlates of failure, whereas RCC prolapse index was the only independent predictor in multivariate analysis (OR: 2.48; 95% CI: 1.06-5.83 per 10% increase; P = 0.037). During a median (IQR) follow-up of 14.3 (8.4-22.8) months, AR progression occurred in 7 (6.8%) patients. Device clamping of the aortic cusp was associated with AR progression (OR: 6.67; 95% CI: 1.10-58.1; P = 0.048). CONCLUSIONS: VSD closure using the MFO is safe and effective, including in patients with outlet-type VSD and AVP. Significant RCC prolapse predicts procedural failure, and clamping of the aortic cusp may compromise long-term valve function.
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Lin et al. (2026) conducted a cohort in Ventricular septal defect (VSD) (n=109). Transcatheter VSD closure using the KONAR-MF Occluder (MFO) was evaluated on Procedural success (95% CI 88.4-98.0). Transcatheter VSD closure using the KONAR-MF Occluder achieved a 94.5% procedural success rate, with significant right coronary cusp prolapse predicting procedural failure (OR 2.48; P=0.037).
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