Midterm results of repair of perimembranous or conal ventricular septal defects using the transaortic direct suture technique

Abstract

Background: A midterm retrospective analysis of the transaortic primary suture repair of perimembranous or conal ventricular septal defects with aortic valve prolapse was conducted.

Methods: From January 1998 to January 2006, 56 patients underwent transaortic repair of perimembranous or conal ventricular septal defects using the direct suture technique. The mean age at operation was 7.7+/-5.0 years (37 males). Twenty-eight patients had none or trivial aortic regurgitation (AR), 19 had mild AR, and 9 had moderate or severe AR. The mean defect size was 7.0+/-2.6 mm at operation.

Results: There was no early mortality. In the immediate postoperative period, AR remained unchanged in 32 patients, improved in 17, and worsened in 9, including 2 patients who required early reoperation. Median follow-up was 3 years (range, 2 months to 8 years). There was 1 late death. Aortic regurgitation had deteriorated in 21 patients, 3 of whom required late reoperation, and improved in 5 compared with the preoperative state. Freedom from deterioration in AR was 97% at 2 years and 71% at 4 years. Deterioration in aortic valve function was independent of demographic and morphologic features.

Conclusions: This surgical technique does not prevent progressive aortic valve dysfunction, which may be related to structural deficiency of the valve leaflet or distortion of the annulus by direct suture closure of the ventricular septal defect. Early closure may prevent structural leaflet damage, whereas adaptation of the transaortic technique to include a shallow ventricular septal defect patch may be beneficial in older patients.