Progression of tricuspid and pulmonary regurgitation following surgical repair of subarterial ventricular septal defect via different approaches: predictors and outcomes.

objectiveSubarterial Ventricular Septal Defect (SVSD) accounts for 10–30% of all VSD cases in Asia, and surgical repair using approaches has not yet been well-defined. However, further investigation is necessary to understand the impact of these approaches on the progression of tricuspid regurgitation (TRP) and pulmonary regurgitation (PRP). As a result, the primary focus of this work is to investigate TRP, PRP and their predictive factors.

methodsThis is a single-center retrospective cohort study that includes 286 SVSD patients with surgical repair from 2018 to 2022. The patients were divided into four subgroups: Group 1, no aortic valve (AV) pathology; Group 2, aortic valve prolapse (AVP) only; Group 3, aortic valve regurgitation (AR) only; Group 4, both AVP and AR. The Kaplan–Meier survival analysis and COX regression were performed to assess TRP and PRP and uncover predictive factors.

resultsAmong the 286 pediatric patients that were followed up postoperatively, 57 were lost to follow-up, and one died. The overall TRP rates at 6, 12, 36, and 60 months were 7.46%, 13.6%, 26.21%, and 37.25%, respectively. There were significant variations in survival curves between Group 1 and 3 or 4 (P < 0.05). The PRP rates at 6, 12, 36, and 60 months postoperatively were 2.63%, 5.7%, 11.67%, and 15.28%, respectively, with no significant variations across subgroups. Preoperative TR grade was partially associated with lower TRP, while the trans-pulmonary approach was considered an independent risk factor for PRP. The trans-pulmonary approach and prognostic nutritional index (PNI) were found to correlate with PRP to ≥ mild.

conclusionSVSD patients exhibit high TRP and PRP rates during mid-to-long-term follow-up. SVSD surgical repair before the onset of AR may contribute to keeping TRP within limits. In addition, preoperative TR severity may be associated with TRP rather than the trans-tricuspid approach. Moreover, the trans-pulmonary approach was found to be a predictor of PRP, with patients with PNI ≤ 58 having a higher likelihood of developing PRP to ≥ mild. However, the optimal cutoff value of PNI for predicting PRP remains to be determined in larger prospective studies. Although the relationship between the trans-pulmonary approach and PNI needs further validation, in clinical practice, it is advisable to repair SVSD using RSI by RSI through TV prior to AR occurrence in a healthy nutritional state.