Transaortic Repair of Postinfarction Ventricular Septal Defect without Ventriculotomy
Lukasz Tulecki, Jeremi Mizerski, Andrzej Janda, Jarosław Bródka, Kacper Wojcik, Konrad Tomkow.
Department of Cardiac Surgery, John Paul II Hospital, Zamosc, Poland.
OBJECTIVE: In spite of constant progress in medical technology, repair of postinfarction ventricular septal defect is still a challenge for the cardiac surgeon. The postero-basal location of this defect is more demanding and associated with higher mortality. An approach through the aortic opening allows to close the defect successfully without ventriculotomy.
METHODS: From 2010 five consecutive patients (58-70 y.o) with the posterior postinfarction ventricular septal defect were operated through the aortic valve opening. An interval between infarction and surgery ranges from 4 to 23 days. In all procedures the ventricular walls remained intact. The only surgical incision was a partial transverse aortotomy. The defects were closed with a synthetic patch using the surgical instruments designed for minimally invasive mitral valve surgery (Fig.1)
RESULTS: In all cases the closure was successful. There was no problem with weaning from the cardiopulmonary bypass and the postoperative bleeding. Early 30-days mortality was 40%, 1 year survival was 40%.
CONCLUSIONS: The transaortic approach in repair of posterior postinfarction ventricular septal defects is feasible and enables to avoid a devastating ventriculotomy. This less invasive technique can be an interesting alternative to traditional methods and may be considered also in combination with percutaneous procedures.
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