Abstract
OBJECTIVE: Subarterial Ventricular Septal Defect (SVSD) accounts for 10–30% of all VSD cases in Asia, and surgical repair using approaches has not yet been well-defined. However, further investigation is necessary to understand the impact of these approaches on the progression of tricuspid regurgitation (TRP) and pulmonary regurgitation (PRP). As a result, the primary focus of this work is to investigate TRP, PRP and their predictive factors. METHODS: This is a single-center retrospective cohort study that includes 286 SVSD patients with surgical repair from 2018 to 2022. The patients were divided into four subgroups: Group 1, no aortic valve (AV) pathology; Group 2, aortic valve prolapse (AVP) only; Group 3, aortic valve regurgitation (AR) only; Group 4, both AVP and AR. The Kaplan–Meier survival analysis and COX regression were performed to assess TRP and PRP and uncover predictive factors. RESULTS: Among the 286 pediatric patients that were followed up postoperatively, 57 were lost to follow-up, and one died. The overall TRP rates at 6, 12, 36, and 60 months were 7.46%, 13.6%, 26.21%, and 37.25%, respectively. There were significant variations in survival curves between Group 1 and 3 or 4 (P < 0.05). The PRP rates at 6, 12, 36, and 60 months postoperatively were 2.63%, 5.7%, 11.67%, and 15.28%, respectively, with no significant variations across subgroups. Preoperative TR grade was partially associated with lower TRP, while the trans-pulmonary approach was considered an independent risk factor for PRP. The trans-pulmonary approach and prognostic nutritional index (PNI) were found to correlate with PRP to ≥ mild. CONCLUSION: SVSD patients exhibit high TRP and PRP rates during mid-to-long-term follow-up. SVSD surgical repair before the onset of AR may contribute to keeping TRP within limits. In addition, preoperative TR severity may be associated with TRP rather than the trans-tricuspid approach. Moreover, the trans-pulmonary approach was found to be a predictor of PRP, with patients with PNI ≤ 58 having a higher likelihood of developing PRP to ≥ mild. However, the optimal cutoff value of PNI for predicting PRP remains to be determined in larger prospective studies. Although the relationship between the trans-pulmonary approach and PNI needs further validation, in clinical practice, it is advisable to repair SVSD using RSI by RSI through TV prior to AR occurrence in a healthy nutritional state. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13019-025-03561-0.