How to anastomose a patch to avoid residual leak in the infarct exclusion method.
infarct exclusion method
postinfarction ventricular septal defect
residual leak
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
pubmed:
31
1
2020
medline:
12
9
2020
entrez:
31
1
2020
Statut:
ppublish
Résumé
Postinfarction ventricular septal defect is a potentially lethal complication of acute myocardial infarction for which surgical repair is mandatory. The infarct exclusion method has contributed to improving surgical outcomes, but a certain percentage of residual leakage continues to be reported. We considered possible mechanisms of residual leakage and modified the sewing method to overcome these mechanisms. A bovine pericardial patch and a Teflon felt strip between the patch and endocardium to achieve good fit were used. The patch and felt were anchored with U stay sutures and reinforced with a running suture. Use of the modified method in seven cases showed improved outcomes. Only one patient had trivial leakage, compared to nine cases using the older method; six of nine patients had residual leaks, including three minor ones. Our method is a rational approach that effectively reduces residual leakage.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Postinfarction ventricular septal defect is a potentially lethal complication of acute myocardial infarction for which surgical repair is mandatory. The infarct exclusion method has contributed to improving surgical outcomes, but a certain percentage of residual leakage continues to be reported. We considered possible mechanisms of residual leakage and modified the sewing method to overcome these mechanisms.
METHOD
METHODS
A bovine pericardial patch and a Teflon felt strip between the patch and endocardium to achieve good fit were used. The patch and felt were anchored with U stay sutures and reinforced with a running suture.
RESULTS
RESULTS
Use of the modified method in seven cases showed improved outcomes. Only one patient had trivial leakage, compared to nine cases using the older method; six of nine patients had residual leaks, including three minor ones.
CONCLUSIONS
CONCLUSIONS
Our method is a rational approach that effectively reduces residual leakage.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
659-661Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Crenshaw BS, Granger CB, Birnbaum Y, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. Circulation. 2000;10:27-32.
Komeda M, Fremes SE, David TE. Surgical repair of postinfarction ventricular septal defect. Circulation. 1990;82:IV243-IV247.
David TE, Dale L, Sun Z. Postinfarction ventricular septal rupture: repair by endocardial patch with infarction exclusion. J Thorac Cardiovasc Surg. 1995;110:1315-1322.
Tashiro T, Toda K, Haruta Y, Yasunaga H, Shibano R, Kawara T. Extended endocardial repair of postinfarction ventricular septal rupture: new operative technique-modification of the Komeda-David operation. J Card Surg. 1994;9:97-102.
Asai T. Postinfarction ventricular septal rupture: can we improve clinical outcome of surgical repair? Gen Thorac Cardiovasc Surg. 2016;64:121-130.