title: The clinical challenge to reduce the postoperative residual shunt in surgical repair of postinfarction ventricular septal perforation.
abstract: Postinfarction ventricular septal perforation (VSP) remains a surgical challenge. The present study describes the use of an interrupted suture technique with the goal of reducing the incidence of postoperative residual shunt. Thirty-four consecutive cases of patients who underwent David's procedure for VSP between 1996 and 2008 were reviewed. A running suture technique was used to close the ruptured septum (C-group: 14 patients) prior to 2002, while the interrupted suture technique (I-group: 20 patients) was used after that point. The overall 30-day mortality was 26.5%, and the mortality rate was not different when comparing the two groups. Postoperative residual shunt was present in five patients (36%) in the C-group and in two patients (10%) in the I-group. In conclusion, use of the interrupted suture technique resulted in a lower incidence of postoperative residual shunt rate. However, the mortality associated with surgical repair of VSP remains high.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai Suita, Osaka 565-8565, Japan. takashim@hsp.ncvc.go.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Murashita
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Komiya
authors.forename: Nobushige
authors.initials: N
authors.lastname: Tamura
authors.forename: Genichi
authors.initials: G
authors.lastname: Sakaguchi
authors.forename: Taira
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Gengo
authors.initials: G
authors.lastname: Sunagawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000401:mortality / Q000601:surgery*