Mid-term results for the use of the extended sandwich patch technique through right ventriculotomy for postinfarction ventricular septal defects

Abstract

Objectives: Postinfarction ventricular septal defect (VSD) is a rare, but feared, complication after acute myocardial infarction. Although numerous techniques and materials have been used, the best technique has not yet been settled upon. We present a novel technique of VSD closure through the VSD via right ventricular (RV) incision and assess short- and mid-term outcomes. Methods: Between April 2008 and March 2012, 15 consecutive patients presenting with postinfarction VSD underwent surgical repair using this technique in our department. Results: Thirty-day mortality was 20% (3 patients). Two patients died from low cardiac output. No early complications related to the VSD repair were observed, such as shunt recurrence, severe septal dyskinesia or pseudoaneurysmal change in the left ventricular myocardium. The left ventricle was contracted well without mitral regurgitation. The mean follow-up period was 17 ± 15 months. The Kaplan-Meier estimate of 3-year cumulative survival is 76%. At the mid-term stage, one trivial residual leak was noted, but no patient required reoperation. RV function was within the normal range after the operation. Conclusions: This method of VSD repair using right ventricle incision and trans-VSD approach is safe and simple and reduces the postoperative recurrence of VSD. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.