Postinfarction ventricular septal rupture: repair by endocardial patch with infarct exclusion

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Postinfarction ventricular septal defect (VSD) is a severe complication of myocardial infarction.
• Surgical repair of acute VSD traditionally involves septal excision, which can be challenging and associated with high mortality.
• A novel approach is needed to improve outcomes for patients with this critical condition.

Purpose of the Study:

• To evaluate the safety and efficacy of a novel operative technique for acute postinfarction ventricular septal defect.
• To assess the impact of this technique on operative mortality, postoperative complications, and long-term survival.
• To analyze the effect on ventricular function post-repair.

Main Methods:

• A consecutive series of 44 patients with acute postinfarction VSD underwent a new surgical technique.
• The method involves left ventriculotomy through infarcted muscle, exclusion of the infarct using a glutaraldehyde-fixed bovine pericardium patch, and simple closure.
• Preoperative assessment included Doppler echocardiography and coronary angiography; most patients were operated on during the acute phase.

Main Results:

• Six operative deaths occurred (13.6%), with severe right ventricular dysfunction identified as the sole independent predictor of mortality.
• Postoperative complications included renal failure (10 patients) and respiratory failure (18 patients).
• Actuarial survival at 6 years was 66% ± 7%, with only one residual VSD. Postoperative echocardiography showed preserved or mildly impaired ventricular function.

Conclusions:

• Repair of acute postinfarction VSD using an endocardial patch with infarct exclusion is a viable technique.
• This method likely minimizes additional right ventricular damage and promotes favorable left ventricular remodeling.
• The technique appears to enhance survival in patients with this high-risk cardiac condition.