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Pitfalls for the “Sandwich technique” via a right ventricular incision to repair post-infarction ventricular septal defects

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An Editorial to this article was published on 09 March 2017

Abstract

Background

We have reported “sandwich technique,” via a right ventricular incision, to treat a post-infarction ventricular septal defect (VSD). This technique involves the placement of patches on both the left and right sides of the septum, pinching the VSD sealed with surgical adhesive between the two patches. In this study, we analyzed factors influencing 1-year mortality to determine the pitfalls in our procedure.

Methods

We evaluated 24 consecutive patients with post-infarction VSD who underwent the “sandwich technique” via a right ventricular incision. One-year survival and major residual leak were used as the criteria for the analysis of survival and technical success, respectively. In protocol 1, clinical variables were evaluated as predictors of one-year mortality. In protocol 2, surgical techniques were evaluated as predictors of major residual leak, which was found to be related to one-year mortality in protocol 1.

Results

In protocol 1, the one-year mortality was higher in patients with major residual leak (75 %, 3/4) than in those without (15 %, 3/20) (p = 0.035). In protocol 2, the patients with major residual leak had smaller patches than those without (41.9 ± 3.8 vs. 47.8 ± 4.8 mm, p = 0.031) and a smaller size difference between the patches and the VSD (22.5 ± 6.5 vs. 30.0 ± 5.7 mm, p = 0.028).

Conclusion

For the “sandwich technique” via a right ventricular approach to treat post-infarction VSD, the choice of patch size according to VSD size is an important variable for reducing major residual leak.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Fujisawa Municipal Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan

    Susumu Isoda, Ichiya Yamazaki & Yusuke Matsuki

  2. Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan

    Kiyotaka Imoto, Keiji Uchida, Norihisa Karube & Keiichiro Kasama

  3. Department of Surgery, Yokohama City University, 3-9 Fukuura Kanazawa, Yokohama, 236-0004, Japan

    Shinichi Suzuki & Munetaka Masuda

  4. Yano Heart Clinic1099-5 Fujisawa, Fujisawa, 251-0052, Japan

    Yoshimi Yano

Authors
  1. Susumu Isoda
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  2. Kiyotaka Imoto
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  3. Keiji Uchida
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  4. Norihisa Karube
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  5. Keiichiro Kasama
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  6. Ichiya Yamazaki
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  7. Shinichi Suzuki
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  8. Yoshimi Yano
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  9. Yusuke Matsuki
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  10. Munetaka Masuda
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Correspondence to Susumu Isoda.

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Isoda, S., Imoto, K., Uchida, K. et al. Pitfalls for the “Sandwich technique” via a right ventricular incision to repair post-infarction ventricular septal defects. Gen Thorac Cardiovasc Surg 65, 187–193 (2017). https://doi.org/10.1007/s11748-016-0722-4

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  • DOI: https://doi.org/10.1007/s11748-016-0722-4

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