Surgical techniques for emergent repair of post-infarction ventricular septal defect: compare endocardial patch and infarct exclusion method with traditional method.
BACKGROUND
The traditional surgical repair of post-infarction ventricular septal defect (VSD) includes excision of necrotic myocardium and approximation of the remaining of healthy ventricular wall and septal portion. The exclusion method emphasizes no excision of infarcted myocardium, preservation of the left ventricular geometry and exclusion of infarction area. We discuss our experiences in 13 patients and compared the results obtained from 2 different surgical methods.


METHODS
From July 1996 to December 2001, 13 patients with post-infarction VSD received emergent repair. Seven patients were repaired in the traditional way and the other 6 with infarct exclusion method. There were 9 men and 4 women, ranging in age from 57 to 79. In the traditional group, all 7 patients were classified as NYHA IV and supported by intra-aortic balloon counter-pulsation (IABP) and 4 patients were for synchronous coronary bypass grafting. Patients using exclusion method were the 1 classified as NYHA III and 5 as IV with cardiogenic shock and supported by IABP. Coronary bypass grafting was performed concomitantly in 2 patients.


RESULTS
Five patients died within 30 days after the surgery. Four patients (mortality rate = 57.1%) had reconstruction in traditional way and 1 (mortality rate = 16.6%) in exclusion way. The complication rate was higher in the traditional group (= 100%, n = 7, p = 0.005). In the traditional group, 1 patient received heart transplantation due to persistent severe pump failure and recovered well. Two received tracheostomy due to respiratory failure and 1 died 2 months later. In the group of exclusion method, 1 patient suffered recurrent VSD 2 days after the first surgery and died due to ventricular arrhythmia.


CONCLUSIONS
The surgical mortality caused by acute post-infarction VSD has decreased with endocardial patch and infarction exclusion method. Rapid diagnosis, appropriate preoperative management and delicate surgical repair improve the overall results and help to attain long-term survival.
Chang
Yu-Lien
YL
Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC.
Hsu-
Chiao-Po
CP
Lai
Shiau-Ting
ST
Yu
Tarng-Jenn
TJ
Weng
Zen-Chung
ZC
Hwang
Jeng-Hsung
JH
Shih
Chun-Tse
CT
Yung
Ming-Chi
MC
Chang
Shiao-Hwang
SH
Wang
Jih-Shiuan
JS
D000368:Aged; D006348:Cardiac Surgical Procedures; D004630:Emergencies; D004699:Endocardium / Q000601:surgery*; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000601:surgery*