Extended Sandwich Patch Technique via Right Ventriculotomy for Acute Ventricular Septal Rupture

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Cardiac Surgery

Background:

• Postinfarction ventricular septal rupture (VSR) repair remains a complex surgical challenge, particularly in acute phases or with posterior VSR.
• The extended sandwich patch technique utilizes large double patches secured with transmural sutures via a right ventriculotomy.

Purpose of the Study:

• To evaluate the early and midterm clinical and echocardiographic outcomes of the extended sandwich patch technique for VSR repair.
• To assess the safety and efficacy of this technique in challenging VSR cases.

Main Methods:

• A retrospective analysis of 33 consecutive patients undergoing VSR repair with the extended sandwich patch technique (2008-2018).
• Patients were categorized into early (<1 week post-MI) and late (>1 week post-MI) surgery groups, including those with posterior VSR.
• Intraoperative transesophageal echocardiography was used to assess shunt presence.

Main Results:

• No residual shunt was detected intraoperatively; however, 2 patients required reoperation.
• 30-day mortality was 20% (early) vs. 12.5% (late), and 1-year survival was 58% (early) vs. 88% (late).
• Significant reduction in right and left heart chamber sizes was observed post-repair, with stable midterm follow-up (median 4.0 years); right heart function remained unchanged.

Conclusions:

• The extended sandwich patch technique through right ventriculotomy offers a safe, simple, and leak-free VSR repair, even for acute or posterior ruptures.
• The technique does not lead to a significant decline in right heart function post-surgery.