Ünlütürk Sahra, Kauling Robert M, Cuypers Judith A A E, van den Bosch Annemien E, Hirsch Alexander, Pelosi Chiara, Bowen Daniel J, Chelu Raluca G, Bogers Ad J J C, Helbing Willem A, Kardys Isabella, Roos-Hesselink Jolien W
Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands.
European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands.
Int J Cardiol Congenit Heart Dis. 2025 Oct 10;22:100624. doi: 10.1016/j.ijcchd.2025.100624. eCollection 2025 Dec.
To evaluate survival, clinical outcome and quality of life (QoL) of patients up to 49 years after surgical ventricular septal defect (VSD) closure.
Single-center, longitudinal cohort study evaluating consecutive patients with surgical VSD closure between 1968 and 1980 with extensive cardiac and QoL evaluation every decade.
Of the original cohort of 174 patients, 39 died (22 %), 8 were lost to follow-up and 38 had not participated previously. Survival rate at 49 years follow-up was 77 % and 86 % when excluding early postoperative mortality. Of the 89 eligible survivors, 76 (85 %) were evaluated (59 % male, median age 49 [44-54] years) with a median follow-up of 44 (range 40-49) years after surgery. Event-free survival at 49 years was 50 %, with symptomatic arrhythmias (10 %), pacemaker implantation (8 %) and VSD-related interventions (3 %) being common complications. At last follow-up, 58 % had left atrial dilation, 25 % had aortic regurgitation and 5 patients (7 %) had a residual VSD. Early postoperative arrhythmias predicted mortality. Both left ventricular (LV) and right ventricular ejection fraction remained stable, with only 1 % having an LV ejection fraction below 45 % at last follow-up. Exercise capacity and VOmax were mildly reduced in 33 % and 49 % of the patients while self-perceived QoL was stable and comparable with the general Dutch population.
Half of the patients with surgical VSD closure had an event-free survival at 49 years. Pacemaker implantation was often needed. Early postoperative arrhythmias predicted mortality. QoL was good and remained stable over time.
评估室间隔缺损（VSD）手术闭合术后49年内患者的生存率、临床结局和生活质量（QoL）。
单中心纵向队列研究，评估1968年至1980年间连续接受VSD手术闭合的患者，每十年进行一次全面的心脏和QoL评估。
在最初的174例患者队列中，39例死亡（22%），8例失访，38例之前未参与。排除术后早期死亡率后，49年随访时的生存率分别为77%和86%。在89例符合条件的幸存者中，76例（85%）接受了评估（男性占59%，中位年龄49[44 - 54]岁），术后中位随访时间为44（范围40 - 49）年。49年时无事件生存率为50%，症状性心律失常（10%）、起搏器植入（8%）和VSD相关干预（3%）是常见并发症。在最后一次随访时，58%有左心房扩大，25%有主动脉瓣反流，5例患者（7%）有残余VSD。术后早期心律失常可预测死亡率。左心室（LV）和右心室射血分数均保持稳定，最后一次随访时只有1%的患者LV射血分数低于45%。33%和49%的患者运动能力和最大摄氧量轻度降低，而自我感知的QoL稳定，与荷兰普通人群相当。
VSD手术闭合患者中有一半在49年时无事件生存。常需要植入起搏器。术后早期心律失常可预测死亡率。QoL良好且随时间保持稳定。
