Midterm results of the "sandwich technique" via a right ventricle incision to repair post-infarction ventricular septal defect

Abstract

Background: Residual shunting and mortality are problems associated with current surgical repair techniques for post-infarction ventricular septal defects. Methods: We describe the mid-term results of the "sandwich technique" to repair a postinfarction ventricular septal defect (VSD), performed via a right ventricle incision. Application of direct ultrasonography to the right ventricular wall enables a surgeon to visualize the region, perform an appropriate incision into the right ventricle, and perform a trabecula resection. One patch is placed on the left ventricular (LV) side and the other on the right ventricular (RV) side of the VSD. The VSD is sealed with gelatin-resorcin-formalin (GRF) glue between the two patches. Results: We had seven consecutive patients. The sandwich technique resulted in geometric preservation of the LV shape. There were no significant leaks, no mortality within a thirtyday postoperative period, and no bleeding problems. Hospital mortality was 14.3% (1/7 cases). Late survival longer than a year was obtained in five cases (71%). The longest patient survival time was nine years. No tissue degeneration was noted. Conclusion: This technique may be useful for repairing a post-infarction VSD. © 2012 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.