Early and late results of entire septal patch technique for post infarction ventricular septal rupture.
OBJECTIVE
Surgical results for post-infarction ventricular septal rupture (VSR) remain poor, even today. The aim of this study was the establishment and clinical evaluation of a simple, standardized septal patch technique for this disease.


METHODS
From 1999 to 2011, 16 consecutive patients with a mean age of 73.1 ± 10.1 (range 55-89) underwent emergency repair of VSR following anterior myocardial infarction. Entire septal patch technique, in which a large pericardial patch is fixed reciprocally between transmural sutures placed in the posterior free wall adjacent to the ventricular septum and anterior left ventriculotomy closing sutures, thus almost entirely covering the septal wall, was used in all cases.


RESULTS
Mean interval between the onset of septal rupture and surgery was 1.3 ± 0.6 (range 1-3) days. Eight patients presented cardiogenic shock and 14 patients underwent preoperative intra-aortic balloon pumping. Average operation, cardiopulmonary bypass, and aortic clamp time were 233 ± 71 (145-360), 128 ± 51 (82-240), and 46 ± 15 (29-76) min, respectively. Coronary artery bypass grafting was performed concomitantly in five cases. Average intra-operative blood loss was 340 ± 184 (123-740) g. Thirty-day mortality was 0 %, and in-hospital mortality was 13.3 % (2/16). Significant residual shunt occurred in one patient. All hospital survivors were followed up with a mean period of 44.5 ± 40 (5-131) months. Five-year survival of all operated patients was 69 ± 14 %.


CONCLUSIONS
Entire septal patch technique proved to be an easily reproducible method for anterior VSR that demonstrated stable early and late results.
Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura, Nagoya, Japan. toshi-i@sannet.ne.jp
Toshiaki
T
Ito
Hiroaki
H
Hagiwara
Atsuo
A
Maekawa
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D015150:Echocardiography, Doppler; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D010496:Pericardium / Q000637:transplantation*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D018658:Ventricular Septal Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*