title: Pitfalls for the "Sandwich technique" via a right ventricular incision to repair post-infarction ventricular septal defects.
abstract: BACKGROUND
  We have reported "sandwich technique," via a right ventricular incision, to treat a post-infarction ventricular septal defect (VSD). This technique involves the placement of patches on both the left and right sides of the septum, pinching the VSD sealed with surgical adhesive between the two patches. In this study, we analyzed factors influencing 1-year mortality to determine the pitfalls in our procedure.
  
  
  METHODS
  We evaluated 24 consecutive patients with post-infarction VSD who underwent the "sandwich technique" via a right ventricular incision. One-year survival and major residual leak were used as the criteria for the analysis of survival and technical success, respectively. In protocol 1, clinical variables were evaluated as predictors of one-year mortality. In protocol 2, surgical techniques were evaluated as predictors of major residual leak, which was found to be related to one-year mortality in protocol 1.
  
  
  RESULTS
  In protocol 1, the one-year mortality was higher in patients with major residual leak (75 %, 3/4) than in those without (15 %, 3/20) (p = 0.035). In protocol 2, the patients with major residual leak had smaller patches than those without (41.9 ± 3.8 vs. 47.8 ± 4.8 mm, p = 0.031) and a smaller size difference between the patches and the VSD (22.5 ± 6.5 vs. 30.0 ± 5.7 mm, p = 0.028).
  
  
  CONCLUSIONS
  For the "sandwich technique" via a right ventricular approach to treat post-infarction VSD, the choice of patch size according to VSD size is an important variable for reducing major residual leak.
authors.affiliation: Department of Cardiovascular Surgery, Fujisawa Municipal Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan. isodasusumu1@gmail.com.
authors.forename: Susumu
authors.identifier: http://orcid.org/0000-0002-3958-3595
authors.initials: S
authors.lastname: Isoda
authors.affiliation: Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Imoto
authors.affiliation: Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Uchida
authors.affiliation: Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Karube
authors.affiliation: Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kasama
authors.affiliation: Department of Cardiovascular Surgery, Fujisawa Municipal Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan.
authors.forename: Ichiya
authors.initials: I
authors.lastname: Yamazaki
authors.affiliation: Department of Surgery, Yokohama City University, 3-9 Fukuura Kanazawa, Yokohama, 236-0004, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Yano Heart Clinic1099-5 Fujisawa, Fujisawa, 251-0052, Japan.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Yano
authors.affiliation: Department of Cardiovascular Surgery, Fujisawa Municipal Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Matsuki
authors.affiliation: Department of Surgery, Yokohama City University, 3-9 Fukuura Kanazawa, Yokohama, 236-0004, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D016896:Treatment Outcome
keywords: Myocardial infarction; Right; Ventricle