Mechanical & Procedural Complications of Ventricular Septal Defect Repair: A Systematic Review

Abstract

Background: Ventricular septal defect (VSD) is the most common congenital cardiac anomaly and remains a major contributor to the global burden of congenital heart disease. It may present as an isolated defect or as part of complex syndromes and can also occur secondary to acquired conditions. Both genetic predisposition and environmental exposures during foetal development significantly influence its occurrence and anatomical complexity. Despite advances in surgical techniques and transcatheter device technologies, VSD closure continues to be associated with clinically relevant mechanical and procedural complications.

Objective: To systematically evaluate the evidence on mechanical and procedural complications associated with surgical and transcatheter VSD repair.

Methods: This systematic review followed PRISMA 2020 guidelines. PubMed, Scopus, and Embase were searched from inception to January 2026. Studies reporting mechanical or procedural complications after surgical or transcatheter VSD repair were included. Data were extracted for study characteristics, patient demographics, VSD type, interventions, and outcomes. Risk of bias was assessed using ROBINS-I and QUADAS-2, and findings were synthesised narratively due to study heterogeneity.

Results: A total of 140 studies met the inclusion criteria. Mechanical complications included residual shunts, atrioventricular conduction abnormalities, valvular injury, ventricular rupture, and haemolysis. Procedural complications comprised device embolisation, arrhythmias, vascular access complications, re-intervention, and procedure-related mortality. Complication profiles varied based on repair modality, defect characteristics, and patient population.

Conclusion: Mechanical and procedural complications remain significant following VSD repair. Improved procedural strategies and standardised reporting are essential to optimise clinical outcomes.