Transcatheter closure of perimembranous ventricular septal defects (pmVSD) has emerged as a less invasive alternative to surgery. Long-term safety remains a concern, particularly regarding conduction disturbances.

The aim of this study is to evaluate the long-term outcomes after transcatheter pmVSD closure using new-generation devices in a single-center cohort.

We conducted a retrospective, single-center study including consecutive patients who underwent transcatheter pmVSD closure between Jan 2014 and Dec 2022. Inclusion required ≥ 3 years of follow-up with available clinical, ECG, and echocardiographic data. Holter monitoring was performed when clinically indicated.

A total of 33 patients were included. Median age at the procedure was 25 years [16–39], with 12 patients (36.4%) < 18 years, 24 patients (72.2%) were male. Devices used were Konar-MF in 23 patients (68.8%), Nit- Occlud in 9 (28.1%), and ADO II in 1 (3.1%). Median follow-up was 3.82 years, ranging from 3 to 10 years. An immediate residual shunt was observed in 18 patients (54.5%), including 14 intra-device and 4 para-device shunts. At last follow-up, only 4 patients had a small residual shunt (3 intra-device, 1 para-device), all hemodynamically insignificant with no indication for reintervention. Baseline aortic regurgitation was present in 8 patients (24.2%), including 4 cases associated with Laubry–Pezzi syndrome. No sustained worsening of aortic regurgitation occurred. Early transient conduction disturbances occurred in 2 patients (6.1%) (first or second degree atrioventricular block) and resolved. One patient (3.3%) developed symptomatic late complete atrioventricular block (cAVB) requiring permanent pacemaker implantation approximately 2 years after the procedure; this patient had pre-existing complete left bundle branch block. No case of infective endocarditis was observed. Left ventricular dimensions decreased over the follow-up, with the mean left ventricular end-diastolic diameter Z -score declining from 2.0 before the intervention to 0.9.

In this single-center cohort with long-term follow-up, transcatheter closure of pmVSD using new-generation devices was safe and effective. Patients with conduction abnormalities before the intervention have a higher risk for cAVB.