Entire septal patch technique for postinfarction ventricular septal rupture

Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry

AIMS

Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken.

METHODS AND RESUTS

Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres. Case note review was undertaken. The primary outcome was long-term mortality. Patient groups were allocated based upon initial management (percutaneous or surgical). Three-hundred sixty-two patients received 416 procedures (131 percutaneous, 231 surgery). 16.1% of percutaneous patients subsequently had surgery. 7.8% of surgical patients subsequently had percutaneous treatment. Times from AMI to treatment were similar [percutaneous 9 (6-14) vs. surgical 9 (4-22) days, P = 0.18]. Surgical patients were more likely to have cardiogenic shock (62.8% vs. 51.9%, P = 0.044). Percutaneous patients were substantially older [72 (64-77) vs. 67 (61-73) years, P < 0.001] and more likely to be discussed in a heart team setting. There was no difference in long-term mortality between patients (61.1% vs. 53.7%, P = 0.17). In-hospital mortality was lower in the surgical group (55.0% vs. 44.2%, P = 0.048) with no difference in mortality after hospital discharge (P = 0.65). Cardiogenic shock [adjusted hazard ratio (aHR) 1.97 (95% confidence interval 1.37-2.84), P < 0.001), percutaneous approach [aHR 1.44 (1.01-2.05), P = 0.042], and number of vessels with coronary artery disease [aHR 1.22 (1.01-1.47), P = 0.043] were independently associated with long-term mortality.

CONCLUSION

Surgical and percutaneous repair are viable options for management of PIVSD. There was no difference in post-discharge long-term mortality between patients, although in-hospital mortality was lower for surgery.

Double-line closure of anterior postinfarction ventricular septal perforation

We describe a modified patch closure technique for repairing subacute anterior ventricular septal perforation. Through a left ventriculotomy, a larger double-layered planar patch is secured with double suture lines to close the defect and cover the ventricular septum. This modification is simple and easy, and may help to avoid a residual shunt.

Repair of acute postinfarct posterior ventricular septal rupture without left ventriculotomy: a stable suture preserving left ventricular geometry

The present article describes the case of a man operated upon for emergency closure of an acute postinfarction defect in the posterior septum. We used a novel technique. The rupture was approached by disconnection of the right ventricular posterior free wall with the exposure of the right side of the septum. First, the edges of the defect were joined together by a single purse-string pledgetted suture. Then an on-site tailored double-folded patch was applied with the aim of closing both the septal defect and the RV access. In our limited experience the technique proved to be safe and effective, allowed optimal exposure of the defect and placement of stable stitches, reducing postoperative complications.