Impact of Device Position and Aortic Valve Prolapse on Outcomes After Transcatheter VSD Closure

BACKGROUND: Transcatheter closure of ventricular septal defect (VSD) is a promising alternative to surgery; however, outcomes in patients with coexisting aortic valve prolapse (AVP) remain limited. OBJECTIVES: The authors aimed to evaluate outcomes and risk factors after VSD closure using the KONAR-MF Occluder (MFO) in a large Asian cohort with a high prevalence of AVP. METHODS: Between 2021 and 2024, consecutive patients undergoing transcatheter VSD closure at our institution using only the MFO were enrolled. Right coronary cusp (RCC) prolapse was quantified using the RCC prolapse index on transesophageal echocardiography. Device position relative to the aortic cusp was classified as nontouching, clamping, or holding. Risk factors for procedural failure and progression of aortic regurgitation (AR) were analyzed. RESULTS: Among 109 cases (13.8%, 15 of 109 doubly committed [Dc] type), 61.5% (67 of 109) had AVP. The procedural success rate was 94.5% (103 of 109; 95% CI: 88.4%-98.0%). Younger age, Dc VSD, aortic rim deficiency, and larger defect size were univariate correlates of failure, whereas RCC prolapse index was the only independent predictor in multivariate analysis (OR: 2.48; 95% CI: 1.06-5.83 per 10% increase; P = 0.037). During a median (IQR) follow-up of 14.3 (8.4-22.8) months, AR progression occurred in 7 (6.8%) patients. Device clamping of the aortic cusp was associated with AR progression (OR: 6.67; 95% CI: 1.10-58.1; P = 0.048). CONCLUSIONS: VSD closure using the MFO is safe and effective, including in patients with outlet-type VSD and AVP. Significant RCC prolapse predicts procedural failure, and clamping of the aortic cusp may compromise long-term valve function.