Faculty Collaboration Database

Technical modifications in the repair of acute ischemic posterior ventricular septal defect without ventriculotomy. J Card Surg 2015 Mar;30(3):233-7

Date

01/13/2015

Pubmed ID

25571774

DOI

10.1111/jocs.12498

Scopus ID

2-s2.0-84924182161 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

OBJECTIVE: Transventricular repair for acute ischemic posterior ventricular septal defect is challenging and is associated with high operative morbidity and mortality. We have adopted the alternative technique of transatrial repair and recently have added technical modifications that result in less residual or recurrent septal shunt. This study reports those modifications and the related outcomes.

METHODS: Retrospective review of 10 patients with acute ischemic posterior ventricular septal defect operated from November 2006 through March 2013. The septal defect was repaired through the right atrium with a prosthetic patch. Interlocking sutures and an additional continuous suture line buttress around the perimeter of the patch were added to the repair in four (40%) patients.

RESULTS: Killip class IV heart failure was present in nine (90%) of the patients, and all received preoperative intra-aortic balloon pump therapy. No patient who received the recent technical modifications experienced a residual or recurrent shunt. However, three (50%) patients who did not undergo this modification developed either a residual septal shunt (n = 1), an early recurrent septal shunt (n = 1), or a ventricular rupture (n = 1). There was no 30-day or in-hospital mortality after surgery, but a single patient died two years after operation due to congestive heart failure. The remaining patients are alive after surgery at a median of 2.0 years.

CONCLUSIONS: The transatrial repair of an acute ischemic posterior ventricular septal defect is a safe technique. The addition of interlocking pledgetted sutures and a patch suture line buttress decreases the incidence of residual and recurrent septal shunt.

Author List

Murashita T, Greason KL, Suri RM, Joyce DL, Stulak JM, Schaff HV

MESH terms used to index this publication - Major topics in bold

Acute Disease
Aged
Cardiac Surgical Procedures
Female
Heart Atria
Heart Septal Defects, Ventricular
Humans
Male
Middle Aged
Myocardial Ischemia
Postoperative Complications
Prosthesis Implantation
Recurrence
Retrospective Studies
Suture Techniques
Treatment Outcome