Timing of repair in ventricular septal defect with aortic insufficiency

Objective: Trusler's valvuloplasty technique and its modifications are the standard approach for the repair of aortic insufficiency in combination with ventricular septal defect. However, recurrent aortic insufficiency may occur after repair. The timing of surgical intervention in patients with ventricular septal defect and aortic insufficiency is still controversial. Methods: Between 1985 and 2000, 33 patients were analyzed retrospectively focusing on echocardiographic findings. For statistical analysis, the patients were divided into two groups according to the grade of preoperative aortic insufficiency: there were 5 patients with preoperative severe aortic insufficiency and 28 patients with mild to moderate aortic insufficiency. Results: The mean age at operation was 6.05 ± 3.61 years. The aortic valve was repaired by means of Trusler's valvuloplasty in the majority of the patients. All but three had patch closure of the ventricular septal defect, with a transaortic approach in 54%. Mean follow-up was 5.1 years with a maximum of 16.9 years (168.9 patient years). Rates for freedom from reoperation at 1, 3, and 8 years were 90%, 85%, and 75%, respectively. In 3 patients, a mechanical prosthesis was implanted at the time of reoperation. One sudden death occurred after 3.6 years. Patients with preoperative severe aortic insufficiency were reoperated significantly more often (p < 0.03). In patients with preoperative severe aortic insufficiency, the underlying pathology (insufficiency) was detected earlier on in life (8.4 ± 10 months) than in patients (45.0 ± 30 months) with mild to moderate aortic insufficiency at the time of intervention (p < 0.05). Conclusion: Severe aortic insufficiency at the time of operation has less favorable long-term results. Therefore, early surgical intervention, even in young patients, seems warranted to avoid potential reoperation or valve replacement.