187 * A MULTIPLE PATCH TECHNIQUE FOR THE TREATMENT OF ISCHAEMIC VENTRICULAR SEPTAL DEFECTS OR CONTAINED VENTRICULAR RUPTURE

Abstract

S 28 EACTS 187 A MULTIPLE PATCH TECHNIQUE FOR THE TREATMENTOF ISCHAEMIC VENTRICULAR SEPTAL DEFECTS OR CONTAINED VENTRICULAR RUPTURE G. Faerber, A. Moschovas, M. Diab, T. Doenst Department of Cardiothoracic Surgery, Friedrich-Schiller University of Jena, Jena, Germany Objectives: Ischaemic ventricular septal defects (VSD) or contained ventricular ruptures (CVR) may pose a considerable surgical challenge, specifically in the acute setting. Perioperative mortality rates of >50% have been described. We describe a novel surgical approach using a multi-layered patch technique. Methods: From November 2010 to November 2013, 13 patients (age 64 ± 15 years) presented with VSD or CVR. Eleven patients had an acute VSD. Three patients had CVR, 2 had subacute pseudoaneurysms located posterolaterally and posteriorly, respectively. One had additionally to VSD a peracute posterior LV rupture with previous coronary artery bypass graft (CABG) years earlier. The operative approach consisted of ventricular incision of the infarcted zone on the arrested (9 patients) or beating heart (4 cases). Closure of the defects was achieved by implantation of a primary Dacron patch with multiple feltenforced U-sutures. A second Dacron patch of significantly greater dimensions was superimposed. A third big pericardial patch was used when haemostasis was not achieved by two patches. The rationale of this multi-layered patch closure is to reduce forces stepwise on the outer patch, allowing haemostasis and avoiding residual shunts. Results: All patients left the operating room haemodynamically stable without redo for bleeding. Overall mortality was 31% (n = 4). Reasons for death were complete occlusion of all peripheral and abdominal arteries (possibly HIT II), severe cerebral insult, multiorgan failure or septic shock. There was no recurrence of VSD.