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[Healing of the operative cardiac wound in postinfarction ventricular septal perforation]
Insights
Comparing cardiac patch materials for postinfarction ventricular septal perforation, the study found Dacron patches superior to equine pericardium (Xenomedica) long-term, despite Xenomedica
Area of Science:
- Cardiac surgery
- Wound healing
- Biomaterials
Context:
- Postinfarction ventricular septal perforation repair
- Comparison of Dacron and Xenomedica patches
- Long-term healing observation
Purpose:
- Evaluate healing processes of cardiac patches
- Compare Dacron vs. Xenomedica patch efficacy
- Assess risks of thrombus formation and infection
Summary:
- Xenomedica patches showed no immediate complications but lacked neoendocardial coverage after 5 months, increasing risks.
- Dacron patches demonstrated neoendothelialization on the right surface by day 30.
- Delayed myocardial healing and suture insufficiency were observed with both patch types.
Impact:
- Dacron patches are preferable for long-term outcomes in ventricular septal defect repair.
- Findings highlight the importance of biomaterial surface properties for cardiac healing.
- Delayed wound healing may be linked to operative trauma and extracorporeal circulation.
Abstract:
We studied the healing processes of operative cardiac wound around the patch on 8 patients (5 males, 3 females), who survived 6 to 147 days postoperatively for postinfarction ventricular septal perforation. The perforation was repaired either with a Dacron patch or with a Teflon-backed glutaraldehyde-preserved equine pericardium (Xenomedica). The patients with the Xenomedica patch had no perioperative bleeding or residual shunting across the patch. However, our long-term observations show that the patch is not covered with neoendocardium after 5 months and thus may pose a greater risk for thrombus formation, embolisms or infections; For instances, one case with mural thrombus formation and two cases of infection around the patch were observed. Therefore, while the Xenomedica patch may provide advantages in the immediate postoperative period, long term results indicate that this patch is inferior to the Dacron patch. We have also observed that the progress of healing was different on the patch between the right and left surface. Neoendocardium was observed on the 30th postoperative day on the right sided surface of the Darcron patch, while only pseudoneointima (mostly fibrinous membrane) with a few endothelial cells were found on the left side. The healing of infarcted myocardium was slower in these patients with patch than in patients with myocardial infarction without operation. Even after 62nd postoperative day, scarring was still incomplete, only granulation tissue was observed. Certainly, the operative trauma including the effect of extracorporeal circulation and postoperative low output syndrome may contribute to this finding. Suture insufficiency occurred in 4 cases, which may be associated with the delayed wound healing.(ABSTRACT TRUNCATED AT 250 WORDS)