Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan.
Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan; Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan.
Ann Thorac Surg. 2022 Apr;113(4):1200-1207. doi: 10.1016/j.athoracsur.2021.04.090. Epub 2021 May 21.
Surgical repair for postinfarction ventricular septal rupture (VSR) was still a challenging operation, especially when required in the acute phase or posterior VSR. The extended sandwich patch technique is characterized by large double patches fixed by circumferential transmural large mattress sutures via right ventricle incision. In the present study, we report early and midterm clinical and echocardiographic outcomes of this technique.
Of 33 consecutive patients undergoing VSR repair using the extended sandwich patch technique between 2008 and 2018, 25 received surgery within 1 week from the onset of myocardial infarction (early group) and 8 received surgery after 1 week (late group), including 12 patients with posterior VSR. All patients underwent surgery within 24 hours of VSR diagnosis.
Intraoperative transesophageal echocardiography identified no residual shunt, but 2 patients received reoperative VSR repair at 9 days and 2 months after the first VSR repair. The 30-day mortality and 1-year survival in the early and late groups were 20% and 12.5%, and 58% and 88%, respectively. After VSR repair, right and left heart chamber sizes were significantly decreased, and these improvements were stable throughout the subsequent follow-up period (median 4.0 years). Tricuspid annular plane systolic excursion and right ventricular fractional area change remained constant throughout the observation period without changing after VSR repair.
The extended sandwich patch technique through a right ventriculotomy offered safe and simple, leak-free repair even in technically demanding acute phase or posterior VSR. No significant decline was found in the right heart function after surgery.
心肌梗死后室间隔破裂（VSR）的外科修复仍然是一项具有挑战性的手术，尤其是在急性期或后 VSR 时需要进行手术。扩展三明治补丁技术的特点是通过右心室切口用环绕穿透的大褥式缝线固定两个大补丁。在本研究中，我们报告了该技术的早期和中期临床及超声心动图结果。
在 2008 年至 2018 年间，连续 33 例接受 VSR 修复的患者中，25 例在心肌梗死发作后 1 周内（早期组）接受手术，8 例在 1 周后（晚期组）接受手术，包括 12 例后 VSR。所有患者均在 VSR 诊断后 24 小时内接受手术。
术中经食管超声心动图未发现残余分流，但 2 例患者在首次 VSR 修复后 9 天和 2 个月接受了再次 VSR 修复。早期组和晚期组的 30 天死亡率和 1 年生存率分别为 20%和 12.5%，58%和 88%。VSR 修复后，右心和左心腔大小明显减小，这些改善在随后的随访期间保持稳定（中位随访时间为 4.0 年）。三尖瓣环平面收缩期位移和右心室分数面积变化在整个观察期间保持不变，在 VSR 修复后没有改变。
通过右心室切开术进行的扩展三明治补丁技术即使在技术要求较高的急性期或后 VSR 中，也能提供安全、简单、无渗漏的修复。手术后右心功能没有明显下降。
