- •The right ventricular incision is close and parallel to the infarct-culprit artery.
- •A large LV-patch, introduced via the VSR, gives wide-enough coverage.
- •The patches are fixed with large transeptal/transmural mattress sutures.
- •All sutures are a safe distance (1.5-2 cm) from the debrided defect edge.
- •BioGlue is inserted in the defect space only after the LV patch is secured.
Postinfarction ventricular septal rupture, or postinfarction ventricular septal defect is rare but lethal if not repaired, and various repair techniques have been tried over many years. However, there still remain problems of high mortality rates and shunt recurrence, particularly in the acute phase and posterior defects. The extended sandwich patch repair via the right ventriculotomy was developed to overcome those problems. The 3 key features are, first, access and eventual closure through the low-pressure right ventricle; second, using the septal defect for a portal to reach into the left ventricle; and third, “sandwiching” the defect between 2 patches, both large enough to be anchored by transmural sutures through relatively stable myocardium. Detailed technical steps are presented here.
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- Surgical repair of ruptured interventricular septum following acute myocardial infarction.Surgery. 1957; 41: 930
- Surgery for postmyocardial infarct ventricular septal defect.Ann Surg. 1977; 186: 260-271
- Surgical treatment of ventricular septal defect complicating acute myocardial infarction. Experience of a north Italian referral hospital.Cardiovasc Surg. 2003; 11: 149-154
- Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the society of thoracic surgeons national database.Ann Thorac Surg. 2012; 94: 436-444
- Surgical repair of postinfarction ventricular septal defect.Circulation. 1990; 82: IV243-IV247
- Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status.J Thorac Cardiovasc Surg. 1990; 99: 798-808
- Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries in cardiogenic shock?.J Am Coll Cardiol. 2000; 36 (3 Suppl A): 1110-1116
- Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (global utilization of streptokinase and TPA for occluded coronary arteries) trial investigators.Circulation. 2000; 101: 27-32
- Postinfarction ventricular septal defect: right ventricular approach-the extended ‘‘sandwich’’ patch.Semin Thorac Cardiovasc Surg. 2012; 24: 59-62
- Extended sandwich patch technique via right ventriculotomy for acute ventricular septal rupture.Ann Thorac Surg. 2022; 113: 1200-1207
- Postinfarction ventricular septal rupture: can we improve clinical outcome of surgical repair?.Gen Thorac Cardiovasc Surg. 2016; 64: 121-130
- Mid-term results for the use of the extended sandwich patch technique through right ventriculotomy for postinfarction ventricular septal defects.Eur J Cardiothorac Surg. 2013; 43: e116-e120
Published online: August 03, 2022
Financial disclosures: The authors declare no conflicts of interest associated with this manuscript.
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