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Survival of Patients With Congenital Ventricular Septal Defect
Quick Takes
- Patients with congenital ventricular septal defect (VSD) have increased mortality as compared with the general population.
- Patients with VSD require lifelong follow-up to identify and manage long-term complications.
Study Questions:
What is the long-term survival of patients with isolated congenital ventricular septal defect (VSD) compared with the general population?
Methods:
Danish nationwide registries were used to identify all patients diagnosed with congenital VSD (n = 9,136) between 1977 and 2018. Patients with chromosomal abnormalities and those with additional cardiac malformations were excluded. Additionally, patients with VSD and Eisenmenger physiology were excluded from the ultimate analysis. Each patient was matched by year of birth and sex to 10 aged-matched controls from the general population.
Results:
Median follow-up was 22 years. VSD patients demonstrated lower survival (p < 0.001) compared with controls with a hazard ratio (HR) of 2.7 (95% confidence interval, 2.4-3.0). The adjusted HR for mortality was 2.7 and 2.8 for patients with unrepaired and surgically closed VSD, respectively.
Conclusions:
The authors concluded that patients with VSD had lower survival compared with the general population.
Perspective:
This study adds to previous work demonstrating that patients with seemingly simple congenital heart disease face higher mortality risk than the general population. While congenital VSD is generally associated with excellent long-term outcomes, this study demonstrated significantly higher mortality in patients with both repaired and unrepaired defects. The cause for this remains unclear but could be related to the lifelong risk of endocarditis, anatomical concerns such as aortic regurgitation or double chamber right ventricle, and arrhythmias. The study supports the need for lifelong expert follow-up for patients with VSD by practitioners trained to identify such issues.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias
Keywords: Aortic Valve Insufficiency, Arrhythmias, Cardiac, Eisenmenger Complex, Endocarditis, Heart Defects, Congenital, Heart Septal Defects, Ventricular, Heart Ventricles, Survival
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