Trans-right Ventricular Repair of Postinfarction Ventricular Septal Rupture: Extended Sandwich Patch Technique

• Published in: Operative techniques in thoracic and cardiovascular surgery 2022, Vol.27 (4), p.364-380
• Main Authors: Asai, Tohru, Vigers, Piers, Kinoshita, Takeshi, Suzuki, Tomoaki
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Cardiogenic shock; Postinfarction ventricular septal defect; Ventricular septal perforation; Ventricular septal rupture
• ISSN: 1522-2942; 1532-8627
• DOI: 10.1053/j.optechstcvs.2022.07.002

•The right ventricular incision is close and parallel to the infarct-culprit artery.•A large LV-patch, introduced via the VSR, gives wide-enough coverage.•The patches are fixed with large transeptal/transmural mattress sutures.•All sutures are a safe distance (1.5-2 cm) from the debrided defect edge.•BioGlue is inserted in the defect space only after the LV patch is secured. Postinfarction ventricular septal rupture, or postinfarction ventricular septal defect is rare but lethal if not repaired, and various repair techniques have been tried over many years. However, there still remain problems of high mortality rates and shunt recurrence, particularly in the acute phase and posterior defects. The extended sandwich patch repair via the right ventriculotomy was developed to overcome those problems. The 3 key features are, first, access and eventual closure through the low-pressure right ventricle; second, using the septal defect for a portal to reach into the left ventricle; and third, “sandwiching” the defect between 2 patches, both large enough to be anchored by transmural sutures through relatively stable myocardium. Detailed technical steps are presented here.