Takeshi Kinoshita1, Tohru Asai2, Kohei Hachiro3, Tomoaki Suzuki3. 1. Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan. Electronic address: kinotakekinotake@yahoo.co.jp. 2. Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan; Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan. 3. Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan.
Abstract
BACKGROUND: Surgical repair for postinfarction ventricular septal rupture (VSR) was still a challenging operation, especially when required in the acute phase or posterior VSR. The extended sandwich patch technique is characterized by large double patches fixed by circumferential transmural large mattress sutures via right ventricle incision. In the present study, we report early and midterm clinical and echocardiographic outcomes of this technique. METHODS: Of 33 consecutive patients undergoing VSR repair using the extended sandwich patch technique between 2008 and 2018, 25 received surgery within 1 week from the onset of myocardial infarction (early group) and 8 received surgery after 1 week (late group), including 12 patients with posterior VSR. All patients underwent surgery within 24 hours of VSR diagnosis. RESULTS: Intraoperative transesophageal echocardiography identified no residual shunt, but 2 patients received reoperative VSR repair at 9 days and 2 months after the first VSR repair. The 30-day mortality and 1-year survival in the early and late groups were 20% and 12.5%, and 58% and 88%, respectively. After VSR repair, right and left heart chamber sizes were significantly decreased, and these improvements were stable throughout the subsequent follow-up period (median 4.0 years). Tricuspid annular plane systolic excursion and right ventricular fractional area change remained constant throughout the observation period without changing after VSR repair. CONCLUSIONS: The extended sandwich patch technique through a right ventriculotomy offered safe and simple, leak-free repair even in technically demanding acute phase or posterior VSR. No significant decline was found in the right heart function after surgery.
BACKGROUND: Surgical repair for postinfarction ventricular septal rupture (VSR) was still a challenging operation, especially when required in the acute phase or posterior VSR. The extended sandwich patch technique is characterized by large double patches fixed by circumferential transmural large mattress sutures via right ventricle incision. In the present study, we report early and midterm clinical and echocardiographic outcomes of this technique. METHODS: Of 33 consecutive patients undergoing VSR repair using the extended sandwich patch technique between 2008 and 2018, 25 received surgery within 1 week from the onset of myocardial infarction (early group) and 8 received surgery after 1 week (late group), including 12 patients with posterior VSR. All patients underwent surgery within 24 hours of VSR diagnosis. RESULTS: Intraoperative transesophageal echocardiography identified no residual shunt, but 2 patients received reoperative VSR repair at 9 days and 2 months after the first VSR repair. The 30-day mortality and 1-year survival in the early and late groups were 20% and 12.5%, and 58% and 88%, respectively. After VSR repair, right and left heart chamber sizes were significantly decreased, and these improvements were stable throughout the subsequent follow-up period (median 4.0 years). Tricuspid annular plane systolic excursion and right ventricular fractional area change remained constant throughout the observation period without changing after VSR repair. CONCLUSIONS: The extended sandwich patch technique through a right ventriculotomy offered safe and simple, leak-free repair even in technically demanding acute phase or posterior VSR. No significant decline was found in the right heart function after surgery.