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Postoperative Aortic Regurgitation in Outflow Ventricular Septal Defect: Determinants of Outcome
Seminars in Thoracic and Cardiovascular Surgery  (IF2.006),  Pub Date : 2021-09-20, DOI: 10.1053/j.semtcvs.2021.09.006
Priya Giridhara, Amitabh Poonia, Deepa S Kumar, Anoop Ayyappan, Kavassery M. Krishnamoorthy, Sivasankaran Sivasubramonian, Ajitkumar Valaparambil

Aortic cusp prolapse is an acquired complication and usually precedes the development of aortic regurgitation (AR) in unoperated outflow ventricular septal defect (VSD). However, its impact on postoperative AR-progression is unknown. 161 patients with outflow-VSD and AR who underwent surgery between 2006 and 2012 were studied retrospectively. 31 patients without prolapse (group-I), 87 with only right coronary cusp (RCC) (group-II), 43 with noncoronary cusp (NCC) prolapse (group-III: 23 only NCC (IIIa), 20 both NCC-RCC (IIIb)) were followed postoperatively for a mean 6.05+/-2.4 years (range 3-12 years). Moderate or severe-AR was present in 4.2%, 36.8%, 52.2% and 80% preoperatively; in 3.2%, 10.3%, 39.1% and 30% patients at follow-up in group-I, II, IIIa, and IIIb, respectively. Although freedom from significant-AR (moderate or severe AR) or aortic valve replacement (AVR) at 10 years was lesser in subaortic-VSD than subpulmonic-VSD (64.3+/-7.5% vs 87.9+/-3.6 %; p =0.02), the difference was not significant when compared within prolapse groups (80+/-8% vs 88.7+/-4.0%, p=0.28 in group-II; 40.7+/-11.8 vs 70+/-14.5%, p=0.48 in group-III). The significant-AR or AVR free survival in patients with trivial or mild preoperative-AR was not significantly different between prolapse groups (98.2+/-1.8% vs 75+/-21.7% in group-II and III respectively; p=0.85). However, in those with moderate or severe preoperative-AR it was significantly lesser in group-III than II (30.1+/-9.8% vs 65.6+/-8.4%, respectively; p=0.04). Group-III, compare to group-II, had 3.28 and 5.24-time risk of development of significant-AR or requirement of AVR, respectively. Prolapse of NCC alone or in addition to RCC prolapse has unfavourable impact on the postoperative outcomes, especially in subaortic-VSD after development of more than mild AR preoperatively.