Early and late results of surgical treatment for ventricular septal rupture with and without use of the infarction exclusion technique--experience with two- and three-sheet modification.
BACKGROUND
Ventricular septal rupture (VSR) is an infrequent but life-threatening situation. Although outcomes have improved with the introduction of infarction exclusion, we have experienced difficulty in determining the optimal patch size and shape for obtaining good outcomes. Therefore, we modified the infarction exclusion technique. Herein, we review our experience on the basis of early closure of VSR with and without use of the infarction exclusion technique.


METHODS
We retrospectively analyzed the hospital records of 33 patients who underwent surgical treatment for VSR. We employed Dagget's method from 1982 to 1995, and then introduced the infarction exclusion technique in 1995. We have developed two modifications: the two-sheet single-patch technique and the three-sheet double-patch technique.


RESULTS
Overall hospital mortality was 41.9% and that of the infarction exclusion group was significantly lower than the hospital mortality rate of the noninfarction exclusion group (21% and 63%, respectively, p = 0.0266). Late mortality of survivors was low in all groups during the observation period. The three-sheet double-patch group showed no residual shunt. This difference in outcomes between the single-patch and double-patch groups was statistically significant (p = 0.0174).


CONCLUSIONS
The two-sheet method facilitates the restoration of ventricular geometry. A double-patch using the three-sheet method may be useful for reducing residual shunt.
Department of Cardiovascular Surgery, School of Medicine, Kinki University, Ohno-Higashi, Osaka-Sayama City, Osaka, Japan. toshio_kaneda@hotmail.com
Toshio
T
Kaneda
Toshihiko
T
Saga
Hitoshi
H
Kitayama
Susumu
S
Nakamoto
Takuma
T
Satsu
Takako
T
Nishino
Kohsuke
K
Fujii
Shintaro
S
Yukami
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000401:mortality / Q000601:surgery*