Infarct Exclusion Technique Research Articles

Early surgical outcomes of a modified infarct exclusion technique in acute post-myocardial infarction ventricular septal rupture: a single-centre experience.

Operative mortality in an acute post-myocardial infarction (AMI) ventricular septal rupture (VSR) is high. In addition to ventricular dysfunction, friable myocardium adds to the technical difficulty of the operation. In a modified infarct exclusion technique, the right ventricle is left undisturbed and the free edge of the pericardial patch is incorporated in the sutures while closing the left ventriculotomy. This simplifies the procedure and decreases the chances of right ventricular dysfunction, any residual defect, and bleeding. A retrospective analysis of patients with VSR following AMI operated in our institute from January 2018 to June 2021 was done. Over the last 3years, 16 patients with AMI VSR were treated with a modified infarct exclusion technique. Eight patients presented in cardiogenic shock preoperatively and were put on intra-aortic balloon pump support. All patients could be weaned successfully from the cardiopulmonary bypass, no patient had any residual defect, and none of the patients required re-exploration for bleeding. Postoperatively, 5 patients died within the first week and 2 more patients subsequently died due to intractable arrhythmias over the next 30days. In our centre, the mortality following repair of VSR after AMI was 43%. The modified infarct exclusion technique is a good technique with less chances of postoperative re-exploration and residual defect.

Early and Late Surgical Outcomes after Geometrical Infarct Exclusion for Post-Infarct Ventricular Septal Perforation.

Ventricular septal perforation (VSP) is a critical complication of acute myocardial infarction. Various surgical procedures for it have been developed; however, surgical outcomes remain unsatisfactory. In 2010, we introduced geometrical infarct exclusion (GIE) as a modification of the Komeda-David technique. This retrospective study compared the surgical outcomes of our geometric infarct exclusion technique to those of other surgical procedures. This study included 38 patients who underwent surgery for VSP. They were divided into patients who underwent GIE (GIE group; n = 17) and those who underwent other procedures (non-GIE group; n = 21). The clinical outcomes of the two groups were compared. Operation, cardiopulmonary bypass, and cardiac arrest times in the GIE group were significantly longer than those in the non-GIE group (p <0.001). A residual shunt was observed in one patient (5.8%) in the GIE group and eight (38.0%) in the non-GIE group (p = 0.026). No patients in the GIE group required a reoperation for the residual shut, while two patients required it in the non-GIE group (p = 0.492). Operative mortality was insignificantly different between the two groups. Geometric infarct exclusion has a longer procedural time than does other surgical procedures but can reduce the rates of residual shunts and reoperations.

Predictors of Mortality in Primary Surgical Repair of Postinfarction Ventricular Septal Defects: The Leipzig Experience.

A postinfarction ventricular septal defect (pVSD) as a complication of acute myocardial infarction (AMI) is associated with high mortality. This retrospective, single-center study aimed to identify predictors of early and long-term outcomes in patients undergoing primary surgical repair of pVSD managed by various surgical techniques. We reviewed data from 77 consecutive patients who underwent primary surgical repair after pVSD in our institution. Prospectively collected demographic and perioperative data were analyzed retrospectively. Predictors of 30-day mortality and long-term outcome were assessed. pVSD was anterior in 45 patients (58.4%) and posterior in 32 (41.6%). Buttressed mattress suture (n = 9, 11.7%), simple single septal patch (n = 34, 44.2%), simple double septal patch (n = 2, 2.6%), sandwich double patch (n = 1, 1.3%), and the infarct exclusion technique (n = 31, 40.3%) were performed for surgical closure. Fifty-three patients (68.8%) had preoperative cardiogenic shock. The 30-day mortality was 42.8% (33 patients). Independent risk factors of 30-day mortality were duration between AMI and surgery <7 days (odds ratio [OR] 5.229, P = .011), preoperative absence of diuretics (OR 6.913, P = .005), and preoperative cardiogenic shock (OR 3.558, P = .011). Cumulative survival rates at 1, 5, and 10 years were 57.1%, 57.1%, and 31.2%, respectively. In pVSD, the 30-day mortality remains high, and preoperative cardiogenic shock significantly influenced mortality in our study. None of the surgical techniques or materials used in our investigation influenced the outcome.

Total Transmural Sutures (TTS) Method, Modified Infarction Exclusion Technique for Ventricular Septal Rupture after Extensive Myocardial Infarction

The infarction exclusion technique using endoventricular continuous sutures for ventricular septal rupture after acute myocardial infarction may be a difficult surgical technique and create residual shunt due to fragile myocardium. We present a patient of ventricular septal rupture (VSR) after extensive anteroseptal myocardial infarction who underwent successful repair using a modified infarction exclusion technique. In our procedure interrupted mattress sutures were placed through the ventricular wall in a way as to exclude the VSR and infarcted muscle of the left ventricle. A heterogeneous pericardial patch is sutured to healthy endocardium in the free and septal wall all around the infarcted area. We describe a procedure for repairing postinfarction VSR, by the infarction exclusion technique with total transmural sutures (TTS) method.

Modified Infarct Exclusion Technique for Repair of Postinfarction Ventricular Septal Rupture

Repair of ventricular septal rupture after acute myocardial infarction remains a surgical challenge. Several techniques for the closure of these defects have been described. This report discusses an infarct exclusion technique modified from the one described by Tirone David and associates. In this technique two separate pericardial patches are used. The first patch excludes the rupture. The second patch is sutured to the margins of the first patch and thus provides strength to the margins of the first patch. The repair is simple and durable and has reduced the incidence of residual ventricular septal defects and patch dehiscence.

Modified double patch repair with infarct exclusion technique for ventricular septal perforation: a case study

BackgroundVentricular septal perforation (VSP) after acute myocardial infarction (AMI) is accompanied by the worsening of rapid hemodynamics, resulting in a poor prognosis. In our department, infarct lesions are preoperatively detected with electrocardiogram (ECG)-synchronized contrast computed tomography, and the scope of approach and exclusion is determined. Furthermore, to effectively prevent a residual shunt, modified double patch repair and infarct exclusion techniques were used in combination to preserve left ventricular (LV) function. This method is reported because it considers both techniques as a surgical procedure that can be accomplished relatively easily and simultaneously.Case presentationWe targeted two consecutive VSP patients who underwent this procedure. It took an average of 1 day from the onset of VSP to surgery. We performed double patch and infarct exclusion for VSP using bovine pericardium via an LV incision. Two patches were marked with a skin pen to anastomose eight mattresses equally. In addition, a one piece-coupled patch was made for infarct exclusion. The two patients were extubated on the day after surgery and intra-aortic balloon pump assistance was also withdrawn. Without perioperative complications, they could leave the intensive care unit after 6.5 days on average. Early postoperative ECG and magnetic resonance angiography showed good LV wall contraction, except at the infarcted area, with no evidence of a residual shunt.ConclusionThe modified double patch repair with infarct exclusion technique is more effective for preventing a residual shunt and maintaining postoperative cardiac function than either of the techniques alone.

Ten-year experience of endocardial linear infarct exclusion technique for ischaemic cardiomyopathy.

To report the mid-term results of our surgical ventricular restoration procedure, called the endocardial linear infarct exclusion technique (ELIET), for ischaemic cardiomyopathy. From 2006 to 2015, 43 consecutive patients who underwent surgical ventricular restoration with ELIET for ischaemic cardiomyopathy were retrospectively analysed. The mean age of patients at surgery was 65.3 ± 9.2 years and EuroSCORE II was 13.7 ± 12.0% (median 9.3%). The mean number of distal anastomoses of coronary artery bypass was 2.8 ± 1.5. A concomitant mitral procedure was performed in 58.1% of patients. The hospital mortality rate was 11.6% (5 patients). The ejection fraction was improved from 24.1 ± 9.2% to 31.7 ± 8.2% in 2 weeks after surgery. The end-systolic left ventricular volume index was effectively reduced, irrespective of performing a concomitant mitral procedure (reduction rate, ELIET: 35.6% vs ELIET + mitral: 39.2%). After ELIET, the sphericity index of the left ventricle did not worsen, and the conicity index was significantly improved. The 5-year estimated rates of survival and freedom from cardiac events were 71.3 ± 7.9 and 61.1 ± 8.3%, respectively. A concomitant mitral procedure was significantly associated with cardiac events based on univariate Cox hazard analysis. This study showed that ELIET can effectively reduce the ventricular volume and create an ellipsoidal left ventricle.

Endocardial linear infarct exclusion technique for infarcted lateral wall.

We report a novel method of surgical ventricular restoration for an infarcted lateral wall: the endocardial linear infarct exclusion technique. First, transmural ventriculotomy is performed at the centre of the scar longitudinally along the coronary artery. Second, the inner layer is sutured in a longitudinal direction with 4-0 polypropylene continuous sutures to approximate the border between the normal and infarcted myocardium. Finally, the outer layer is closed with a combination of interrupted buttress and continuous over-and-over sutures with outer felt reinforcement. The advantages of endocardial linear infarct exclusion technique are as follows: the risk of bleeding is low; it is not technically demanding and is reproducible; the coronary artery can be preserved; approximation of the base of the anterior and posterior papillary muscles is possible in the case of ischaemic mitral regurgitation and it can also be applied to the anterior and inferior walls.

Alternative method of patch implantation and creation for postinfarction ventricular septal defect repair by the infarct exclusion technique

Alternative method of patch implantation and creation for postinfarction ventricular septal defect repair by the infarct exclusion technique

心室中隔穿孔の外科治療

心室中隔穿孔の外科治療

Surgical Outcomes of a Modified Infarct Exclusion Technique for Post-Infarction Ventricular Septal Defects.

BackgroundPostinfarction ventricular septal defects (pVSDs) are a serious complication of acute myocardial infarctions. The aim of this study was to analyze the clinical outcomes of the surgical treatment of pVSDs.MethodsThe medical records of 23 patients who underwent operations (infarct exclusion in 21 patients and patch closure in two patients) to treat acute pVSDs from 2001 to 2011 were analyzed. Intra-aortic balloon counter-pulsation was performed in 19 patients (82.6%), one of whom required extracorporeal membrane support due to cardiogenic shock. The mean follow-up duration was 26.2±18.6 months.ResultsThe in-hospital mortality rate was 4.3% (1/23). Residual shunts were found in seven patients and three patients required reoperation. One patient needed reoperation due to the transformation of an intracardiac hematoma into an abscess. No patients required reoperation due to recurrence of a ventricular septal defect during the follow-up period. The cumulative survival rate was 95.5% at one year, 82.0% at five years, and 65.6% at seven years.ConclusionThe use of a multiple-patch technique with sealants appears to be a reliable method of reducing early mortality and the risk of significant residual shunting in patients with pVSDs.

Simultaneous surgical repair of post-infarct ventricular septal defect, left ventricular aneurysm and coronary artery disease

A 52 years old patient was admitted in our hospital for postinfarction ventricular septal defect, left ventricular aneurysm and coronary artery disease. He was investigated by echocardiography and coronary angiography and proposed for operation. In the light of the patient’s stable haemodynamic condition, surgical intervention was delayed. 3 weeks following the acute myocardial infarction open heart surgery was performed and had been managed just preoperatively with an intra-aortic balloon pumping. The patient underwent successful ventricular septal defect closure with a patch. The repair involves ventricular septal defect closure and infarct exclusion technique. The patient discharged 10 days postoperatively. We consider that this modification is a simple and effective way to decrease the surgical risk of postinfarction ventricular septal defect.

Surgical repair of post infarcted ventricular septal perforation with infarct-exclusion technique

Surgical repair of post infarcted ventricular septal perforation with infarct-exclusion technique

Long Term Outcome of Ventricular Septal Perforation after Post-infaction^|^mdash;The Efficiency of Double-Patch Repair with a Bilateral Ventriculotomy^|^mdash;

Objectives: Repair of a postinfarction ventricular septal perforation (VSP) had been a difficult procedure with a high risk of postoperative residual shunt and subsequent mortality. This retrospective study aimed to assess a modified infarct exclusion technique with a biventricular approach. Methods: Thirty three consecutive patients who underwent the infarct exclusion procedure for VSP between 2002 and 2013 were reviewed. A biventricular approach (B group: 9 patients) and a left ventricular approach (L group: 24 patients) were analyzed. Results: The overall 30-day mortality of B and L group was 11%, and 21%, respectively, and there was not different between the two groups (p=0.53). No postoperative residual shunt was observed in the B group, however 8 cases in the L group (p=0.034). The overall five-year survival rate in the B and L group was 89% and 61%, respectively (p=0.19), however, the survival rate at five years revealed that significant difference between with and without residual VSP. Conclusion: The repair of post-infarction VSP can be safely performed by the infarct exclusion technique with a biventricular approach. This technique contributed to reduce surgical mortality and prevented recurrence of the VSP.

急性心筋梗塞後心室中隔穿孔に対する一側心室アプローチによるdouble patch + infarct exclusion法

急性心筋梗塞後心室中隔穿孔に対する一側心室アプローチによるdouble patch + infarct exclusion法

Surgical Repair of Ventricular Septal Defect after Myocardial Infarction: A Single Center Experience during 22 Years

BackgroundSurgical repair of post-infarct ventricular septal defect (VSD) is considered one of the most challenging procedures having high surgical mortality. This study aimed to evaluate the outcomes of the surgical repair of post-infarct VSD.MethodsFrom May 1991 to July 2012, 34 patients (mean age, 67.1±7.9 years) underwent surgical repair of post-infarct VSD. A retrospective review of clinical and surgical data was performed.ResultsVSD repair involved the infarct exclusion technique using a patch in all patients. For coronary revascularization, 12 patients (35.3%) underwent concomitant coronary artery bypass graft, 3 patients (8.8%) underwent preoperative percutaneous coronary intervention, and 9 patients (26.5%) underwent both of these procedures. The early mortality rate was 20.6%. Six patients (17.6%) required reoperation due to residual shunt or newly developed VSD. During follow-up (median, 4.8 years; range, 0 to 18.4 years), late death occurred in nine patients. Overall, the 5-year and 10-year survival rates were 54.4%±8.8% and 44.3%±8.9%, respectively. According to a Cox regression analysis, preoperative cardiogenic shock (p=0.069) and prolonged cardiopulmonary bypass time (p=0.008) were independent predictors of mortality.ConclusionThe early surgical outcome of post-infarct VSD was acceptable considering the high-risk nature of the disease. The long-term outcome, however, was still dismal, necessitating comprehensive optimal management through close follow-up.

Double-Patch Repair by a Bilateral Ventriculotomy for Postinfarction Ventricular Septal Defect

Repair of a postinfarction ventricular septal defect (VSD) is a challenging procedure with a high risk of postoperative residual shunt and subsequent mortality. This retrospective study aimed to assess a modified infarct exclusion technique with a biventricular approach. Nineteen consecutive patients who underwent the infarct exclusion procedure for VSD between 2002 and 2011 were reviewed. A biventricular approach (B group: 6 patients) and a left ventricular approach (L group: 13 patients) were studied by univariate analysis. The overall 30-day mortality was 15.8%, and was not different between the two groups (p=0.94). Postoperative residual shunt was not observed in the B group (p=0.21). The overall five-year survival rate was 79%, and there were no late deaths in the B group (p=0.14). The repair of postinfarction VSD can be safely performed by the infarct exclusion technique with a biventricular approach. This technique seems to reduce surgical mortality and prevents recurrence of the VSD.

Successful infarct exclusion for postinfarction left ventricular free wall rupture

The mortality of postinfarction left ventricular free wall rupture is still high. Several surgical techniques have been used for repairing such ruptures. Here, we describe using an infarction exclusion technique to successfully treat a case of a blow-out type postinfarction left ventricular free wall rupture. This technique has frequently been used for repairing postinfarction ventricular septal perforation. In this case, infarcted myocardial tearing was prevented, and complete haemostasis was achieved by infarct exclusion.

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

Treatment for postinfarction ventricular septal defect has been improving for several decades. Aggressive resection of the infarcted myocardium (infarctectomy and closure technique) and preserving infarcted myocardium (infarct exclusion technique) have been technically modified. Recent improvement includes use of surgical glue, using an additional patch for infarct exclusion, septal exclusion, sandwich technique via right or left ventricular approach, and endovascular repair. This field still has room for cardiac surgeons to improve surgical strategy and technique.

Management and midterm outcomes of post-infarction ventricular septal defect

We assessed midterm outcomes, predictors of mortality, and residual defects after repair of post-infarction ventricular septal defect in 10 patients (mean age, 65.3 years; range, 50-78 years) who were operated on between 2000 and 2008. Mean time from onset of symptoms of myocardial infarction to diagnosis of ventricular septal defect was 3.5 days. Time from diagnosis to surgery ranged from 6 h to 84 days. The defects were located anteriorly in 4 patients and posteriorly in 6. Patch reconstruction of the septum was used in 6 patients and the infarct exclusion technique in 4. Hospital mortality was 60%. The only predictor of mortality was tricuspid valve competence (p = 0.048). There was no correlation between location of the defect or type of repair and operative mortality. Residual or recurrent ventricular septal defect was noted in 6 patients. Location of the defect and type of repair were not predictors of residual or recurrent defects. Residual ventricular septal defect was not associated with increased short-term mortality or reduction of functional status. Early mortality associated with post-infarction ventricular septal defect repair is significant. Discharged patients continue to have good functional capacity and quality of life, as well as favorable midterm survival.