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

Objective: Although untreated post-infarction ventricular septal defect (VSD) in acute phase has a high mortality rate, surgeons are reluctant to perform emergent surgery due to fragility of the infarcted myocardium. We have reported the “sandwich technique,” via a right ventricular (RV) incision, to treat a post-infarction VSD even in the ultra-acute phase. This technique involves the placement of patches on both sides of the septum, pinching the VSD sealed with surgical adhesive between the two patches; the surgical adhesive fixes and strengthens the fragile infarcted tissue. One-year mortality was found to be related to a major residual leak. In this study, we attempted to determine the location of the leak after the repair using the sandwich technique via an RV incision to treat post-infarction VSD. Materials and Methods: We evaluated 27 consecutive patients with post-infarction VSD who underwent repair using the “sandwich technique” via an RV incision in our series. The location of the major leak was divided into eight segments around the VSD. Results: The mean duration from onset to operation was 2.0 days, with 78% of patients being operated in two days and 96% patients operated in one week. The 30-day mortality rate was 4%, and 1-year mortality rate was 30%. The segments were divided into four areas: apical area (6/13, 46%), free wall side area (3/13, 23%), cranial area (3/13, 23%), and septal area (1/13, 8%). Conclusion: The location of the leak seemed to be related to the ischemic myocardial damage depending on the absence of collateral circulation. Surgical strategy should be established to prevent and repair residual leak.