Do patients with a congenital ventricular septal defect have a lower overall survival than the general population?
This study found that the long-term survival of patients with VSD is reduced compared with the general population regardless of treatment rendered (ie, surgically repaired or not).
These Danish investigators analyzed data obtained from multiple health registries in Denmark and identified all patients with a congenital ventricular septal defect (VSD) in the period from 1977 to 2018. Patients with concomitant atrial septal defect (ASD) were also eligible for study inclusion. Exclusion criteria included a history of an acute myocardial infarction diagnosis before the VSD diagnosis was established, chromosomal abnormalities, and concomitant congenital cardiac malformations other than ASD. Matching by year of birth and sex occurred for all case patients (n = 9136) to 10 control patients without congenital heart disease or VSD. Mean follow-up occurred for 22.1 years.
Patients with VSD had a significantly lower long-term survival than matched control patients (hazard ratio = 2.7; 95% CI 2.4 - 3.0 for mortality rate per 10,000 person years). Long-term survival was similarly reduced in patients with VSD irrespective of whether surgical closure occurred. Cardiac-related death was the most common cause of death in patients with both unrepaired and surgically closed VSD. Early diagnosis of VSD (in patients younger than 18 years) was associated with a significantly increased premature mortality risk compared with diagnosis at 18 years or older.
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill