Post-infarction Ventricular Septum Rupture (PIVSR). Surgical Correction with "Butterfly patch": the Experience of 80 Consecutive Cases

Mikhail D. Alshibaya, Zurab M. Cheishvili, Konstantin V. Krymov

Bakulev Scientific Medical Centre for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–A

Abstract

The new method of PIVSR closure with double-leaflet “butterfly patch” was designed by us in 2006.The aim of the study is to present early and late results of a new method of surgical correction for PIVSR in combination with myocardial revascularisation. Materials & Methods. 80 pts were operated upon between Jan. 2006 and Sept. 2017. There were 44 male and 36 female pts. All patients were preoperatively in NYHA class IV. 41 pts suffered anterior myocardial infarction (MI) and 39 pts had MI of posterior left ventricular (LV) wall. The time interval between the onset of AMI and operation varied from 3 to 1456 days, mean 31±14 days. Mean VSR size was 18±6 mm, LVEF - 44±11%, pulmonary artery (PA) pressure - 61±14 mm Hg. 50 pts suffered significant tricuspid valve insuffiency. All patients were operated under cardio-pulmonary bypass and Custodiol cardioplegia. Intraaortic balloon pumping was used preoperatively in 52 pts. The correction was performed trough left ventriculotomy in most cases. Tricuspid valve annuloplasty (TVA) was performed in 50 cases (62%).The mean number of coronary artery bypasses was 2,1±0,5. Results. In-hospital mortality rate was 16,25% (13/80). The reasons of death were progressive heart failure due to residual left-to-right shunt andpneumonia. Early recanalisation of VSD took place in 6 pts (8,25%), five of them were reoperated. The main risk factors of in-hospital mortality were: operation within two weeks after onset of AMI, LVEF below 40% and pre-operative pneumonia. In follow-up period (mean 6,4±1,1 years) 75% of pts discharged from the hospital are alive. Conclusions. 1. The new simple method PIVSD surgical correction with "butterfly patch" proved its efficacy and led to acceptable early and good late results. 2. Concomitant TVA is necessary in approximately 2/3 of cases. 3.Most serious risk factor is early operation due to hemodynamic instability and technical challenges.