Labrousse L, Choukroun E, Chevalier J M, Madonna F, Robertie F, Merlico F, Coste P, Deville C
Department of Cardio-Vascular Surgery, Hopital Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France.
Eur J Cardiothorac Surg. 2002 Apr;21(4):725-31; discussion 731-2. doi: 10.1016/s1010-7940(02)00054-4.
Repair of post infarction ventricular septal defect (VSD) is still a challenging procedure with a high risk of recurrence of the VSD and subsequent mortality. The aim of this retrospective study was to assess if technical change in the surgical procedure was followed by an improvement in recurrence of the VSD and operative results.
This retrospective study from 1971 to 2001 included 85 patients operated on early (<15 days) after the occurrence of a post infarction VSD. Double patch technique was introduced in 1986. A total of 44 variables were studied by a uni- and multivariate analysis.
Hospital death occurred in 36 patients. Significant factors for hospital mortality included: preoperative and evolution of the clinical status, right ventricular function and type of repair (one or two patches). Moreover, no recurrence was observed in patients repaired with the double patch technique (P=0.09). None of the studied variables were significant for long term survival. Concomitant CABG was not associated with higher hospital mortality and long-term survival rate was similar in patients with or without concomitant CABG.
The use of the double patch technique and glue by avoiding recurrence of the VSD played a role in the reduction of the hospital mortality. This technique has to be recommended in the early repair of post infarction VSD. Concomitant CABG can be done safely to control the added risk of an associated coronary artery lesion.
心肌梗死后室间隔缺损（VSD）的修复仍是一项具有挑战性的手术，VSD复发风险高且后续死亡率高。这项回顾性研究的目的是评估手术操作技术的改变是否会带来VSD复发率的改善和手术结果的提升。
这项1971年至2001年的回顾性研究纳入了85例在心肌梗死后VSD发生早期（<15天）接受手术的患者。1986年引入了双层补片技术。通过单变量和多变量分析对总共44个变量进行了研究。
36例患者发生院内死亡。院内死亡的显著因素包括：术前及临床状态的演变、右心室功能和修复类型（一个或两个补片）。此外，采用双层补片技术修复的患者未观察到复发（P=0.09）。所研究的变量均对长期生存无显著影响。同期冠状动脉旁路移植术（CABG）与较高的院内死亡率无关，有无同期CABG的患者长期生存率相似。
双层补片技术和胶水的使用通过避免VSD复发，在降低院内死亡率方面发挥了作用。在心肌梗死后VSD的早期修复中推荐使用该技术。同期CABG可安全进行，以控制相关冠状动脉病变带来的额外风险。
