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Williams AR, Moya-Mendez ME, Mehta S, Vekstein A, Harrison JK, Milano CA, Plichta RP, Haney J, Schroder JN, Zwischenberger B, Glower D, Gaca JG. Infarct exclusion repair of postmyocardial infarction ventricular septal rupture with a hybrid patch and septal occluder device compared with patch only. JTCVS Tech 2023; 22:228-236. [PMID: 38152175 PMCID: PMC10750469 DOI: 10.1016/j.xjtc.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/09/2023] [Accepted: 07/22/2023] [Indexed: 12/29/2023] Open
Abstract
Objective We developed a hybrid technique for repairing post-myocardial infarction (MI) ventricular septal defect (VSD) that combines infarct exclusion with patch and a nitinol-mesh septal occluder device (SOD) to provide a scaffold to support the damaged septal wall. Here, we compare outcomes of patients with post-MI VSD repaired using patch only or hybrid patch/SOD. Methods Patients undergoing post-MI VSD repair at our institution from 2013 to 2022 who received patch alone or patch/SOD repair were analyzed. Primary outcome was survival to hospital discharge. Clinical outcomes and echocardiograms were also analyzed. Results Over a 9-year period, 24 patients had post-MI VSD repair at our institution with either hybrid patch/SOD (n = 10) or patch only repair (n = 14). VSD size was 18 ± 5.8 mm for patch/SOD and 17 ± 4.6 mm for patch only. In the patch/SOD repair cohort, average size of SOD implant was 23.6 ± 5.6 mm. Mild left ventricular dysfunction was present prerepair and was unchanged postrepair in both groups; however, moderate-to-severe right ventricular (RV) dysfunction was common in both groups before repair. RV function worsened or persisted as severe in 10% of hybrid versus 54% of patch-only patients postrepair. Tricuspid annular systolic excursion and RV:left ventricle diameter ratio, quantitative metrics of RV function, improved after patch/SOD repair. No intraoperative mortality occurred in either group. Postoperative renal, hepatic, and respiratory failure requiring tracheostomy was common in both groups. Survival to hospital discharge in both cohorts was 70%. Conclusions Post-MI VSD repair with patch/SOD has comparable short-term outcomes with patch alone. Addition of a SOD to patch repair provides a scaffold that may enhance the repair of post-MI VSD with patch exclusion.
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Affiliation(s)
- Adam R. Williams
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Mary E. Moya-Mendez
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Sachin Mehta
- Division of Cardiothoracic Anesthesia, Department of Anesthesia, Duke University Hospital, Durham, NC
| | - Andrew Vekstein
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - J. Kevin Harrison
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, NC
| | - Carmelo A. Milano
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Ryan P. Plichta
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - John Haney
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Jacob N. Schroder
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Brittany Zwischenberger
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Donald Glower
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Jeffrey G. Gaca
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
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