Surgical strategy for multiple ventricular septal defects: long-term outcomes beyond 15 years.

OBJECTIVES

This study aimed to elucidate the long-term surgical outcomes of multiple ventricular septal defects and to determine the appropriate closure techniques according to the size, distribution, and morphology of muscular defects.

METHODS

A single-institutional retrospective review was performed in 127 patients with multiple ventricular septal defects who underwent biventricular repair between February 2005 and November 2020.

RESULTS

The cohort included 52 patients with Swiss cheese ventricular septal defects (40%) and 48 with associated cardiac malformation (37%). Among 294 repaired muscular defects, 246 (83%) were closed with the re-endocardialization technique. The felt sandwich technique or patch closure was applied to 37 muscular defects in 34 patients, including spurious multiple defects (n = 14), large defects (n = 11), and border defects (n = 9). Three of them were small but closed with the felt sandwich technique in our initial experience. The overall survival and freedom from reoperation rates at 15 years after the definitive surgery were 97.6% and 96.7%, respectively. No patient required permanent pacemaker implantation. Presence of Swiss cheese ventricular septal defects, the use of prosthetic materials, and patient body size did not negatively impact global septal motion. At the latest follow-up, 117 patients (94.3%) were New York Heart Association functional class Ι without exercise restriction.

CONCLUSIONS

The surgical strategy incorporating the re-endocardialization and felt sandwich technique provided favorable long-term outcomes. The re-endocardialization technique should be considered the procedure of choice for the majority of muscular defects, whereas large, border, or spurious multiple defects can be managed with the felt sandwich technique.