Surgical repair of postinfarction ventricular septal defect by infarct exclusion.
Repair of postinfarction ventricular septal defect (VSD) by infarct exclusion has been used for a decade in our unit. It involves securing a glutaraldehyde-preserved bovine pericardial patch to the endocardium of the left ventricle all around the necrotic myocardium to exclude the VSD and the infarct from the left ventricular cavity. Fifty-two patients with postinfarction VSD underwent this type of repair from 1987 to 1996. Thirty-four patients were in shock when undergoing operation; 26 had anterior VSD and 26 had posterior. Ten patients died perioperatively, for surgical mortality of 19%. Three patients developed recurrent VSD; one died and two survived. Preoperative cardiogenic shock and age older than 70 years were associated with an increased operative mortality. Operative survivors were followed up from 6 to 135 months, mean of 65 months. The actuarial survival at 8 years was 59% +/- 6%. Repair of postinfarction VSD by infarct exclusion is a relatively simple operative procedure and seems to have improved the results of surgery in patients with posterior VSD.
David
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Division of Cardiovascular Surgery of The Toronto Hospital and University of Toronto, Ontario, Canada.
Armstrong
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D000206:Actuarial Analysis; D000368:Aged; D000818:Animals; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002417:Cattle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery; D010496:Pericardium / Q000637:transplantation; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D018658:Ventricular Septal Rupture / Q000401:mortality / Q000601:surgery*