“Sandwich Technique” via a Right Ventricular Incision for Ultra-acute Repair of Post-infarction Ventricular Septal Defects

Post-infarction ventricular septal defect (VSD) is a life-threatening complication of transmural acute myocardial infarction (AMI), with a poor survival rate despite medical therapy 1, . Untreated patients had a 24% mortality rate in a day and 80% within the first month 3, . Although surgical repair seems to provide better result than medical therapy, surgical results in 2014 in Japan showed 28.6% 30-day mortality rate and 33.5% in-hospital mortality rate 5, . The Society of Thoracic Surgeons database showed operative mortality rate of 54.1% when repair was attempted within 7 days after AMI . Although untreated post-infarction VSD in the ultra-acute phase has an extremely high mortality rate, surgeons are reluctant to perform emergent surgery due to fragility of the infarcted myocardium. Problems with the previous surgical techniques include residual leak, uncontrolled bleeding, and technical difficulty 2, -. To resolve these problems, we have developed a sandwich technique via a right ventricular (RV) approach -. 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 via an RV approach (Fig. 1a). Since patients with post-infarction VSD tend to fall in severe lung edema or cardiac tamponade quickly and the condition sometimes become irreversible, necessitating postoperative cardiopulmonary support, we used our technique in the ultra-acute phase, with the Original Article