Aortic regurgitation following transcatheter closure of perimembranous ventricular septal defect in children: risk factors and long-term outcomes

Postprocedural aortic regurgitation (AR) is a challenging complication following transcatheter device closure of perimembranous ventricular septal defects (pmVSD) in pediatric patients. This study aimed to identify risk factors for AR and evaluate its long-term outcomes. A total of 1,427 children who underwent successful pmVSD closure between June 2002 and August 2023 were retrospectively analyzed, with a median follow-up of 80 months (range, 12 to 248). Patients were further divided into early (2002-2016) and late (2017-2023) eras to assess temporal effects. Postprocedural AR occurred in 157 patients (11.0%), including 151 new-onset and 6 aggravated cases. AR was mostly trivial or mild, with 3 moderate cases (one requiring early valve repair). AR developed in 105 patients early after closure and in 52 during follow-up. Multivariate analysis identified repeated track creations (odds ratio [OR]: 2.000; 95% confidence interval [CI]: 1.286 to 3.112; P = 0.002) and opening the left disk above the aortic valve (OR: 5.071; 95% CI: 2.476 to 10.389; P < 0.001) as independent risk factors. Subgroup analysis showed consistent findings in the early era, whereas a smaller subaortic rim emerged as an additional risk factor in the late era. At the last follow-up, 2 patients had moderate AR, 10 mild, and 62 trivial. In conclusion, most AR cases after pmVSD closure are mild or trivial with favorable long-term outcomes. Minimizing repeated track creations and avoiding opening the left disk above the aortic valve may help reduce AR risk, whereas a smaller subaortic rim may increase its likelihood.