Double patch technique for repairing postinfarction ventricular septal defect

Abstract

We report 2 cases in which the double patch technique was used to repair an anterior postinfarction ventricular septal defect. To do this, we modified infarct exclusion as follows: In addition to a conventional patch excluding the infarcted muscle, another small patch is used to directly close the septal defect. Gelatin-resorcin-formal glue is applied between the double patches, which prevent the glue from being washed away and enhance it to polymerize stably, thereby rapidly stabilizing the infarcted myocardium with the endocardial patch. Echocardiography immediately after operation showed the infarcted septum had completely adhered to the endocardial patch. Both patients demonstrated satisfactory postoperative hemodynamics. Although 1 patient did well, the other died 6 months postoperatively due to complications of pneumonia and gastrointestinal bleeding secondary to colon carcinoma. This double patch technique appears useful, although further experience is needed to verify its safety and efficacy.

Midterm Results of the ^|^#8220;Sandwich Technique^|^#8221; via a Right Ventricle Incision to Repair Post-Infarction Ventricular Septal Defect

“…7) The double patch technique, in which the patch is reinforced with GRF glue, seems to prevent shunting, but the potential problem of LV geometry change still remains. 8,9) The sandwich technique described in this report (Fig. 2) is simple and technically easy to perform, compared with techniques previously reported.…”

Surgical Repair of Postinfarction Ventricular Septal Defects^|^mdash;2013 Update

“…In the past several decades, several approaches have been developed to improve treatment outcome. Such approaches are infarctectomy and closure, [10][11][12] infarct exclusion, [13][14][15][16] use of surgical glue, 17,18) using an additional patch for infarct exclusion, 19,20) septal exclusion, 21,22) sandwich technique, [23][24][25][26][27] and percutaneous approach. 28) …”

“…34,38) Patients who are in an intermediate position between shock and a stable condition should be operated on promptly (usually within 12 to 24 hours), after an appropriate preoperative evaluation. Prolonged intraaortic balloon pump support before surgery may be beneficial in select patients; 35,39) however, for most patients in an acute clinical setting, recent improvements in surgical techniques [17][18][19][20][21][22][23][24][25][26][27] has enabled rapid surgery in which the advantage of reducing the risk of hemodynamic deterioration seems to exceed disadvantage of surgical difficulty.…”

“…Musumeci, et al and other surgeons applied gelatin-resorcin-formol (GRF) biological glue (Pharmacie Centrale, CHU, Henri Mondor, Creteil, France) as a sealant between the patch and the interventricular septum in the exclusion technique. 17,19,20,22) They proposed that GRF glue reinforcement enabled the early repair of a VSD and prevented the formation of a residual shunt. GRF glue seems to have three to seven times the adhesive force of fibrin glue.…”

“…The second patch plays a role in preventing leaks or glue embolization. Tabuchi, et al 19) (Fig. 4B) reported a repair with a double patch by first using a large patch sewed to the endocardium (i.e., excluding myocardial infarction) and a second small direct patch sewed to close septal defect; GRF glue was applied to the space between first and second patches.…”