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Patch exclusion technique with Amplatzer septal occluder device for the treatment of postinfarction ventricular septal defect.

ABSTRACT:

SUBMITTER: Madou ID

PROVIDER: S-EPMC8302874 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Patch exclusion technique with Amplatzer septal occluder device for the treatment of postinfarction ventricular septal defect.

Madou Isidore Dinga ID Williams Adam R AR Gaca Jeffrey G JG

JTCVS techniques 20200411

PMID: 34317870

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Project description:BackgroundPostinfarction ventricular septal defect (VSD) is a catastrophic complication of myocardial infarction. Surgical repair still has poor outcomes. This report describes clinical outcomes after a novel hybrid transcatheter/surgical repair in patients with apical VSD.MethodsSeven patients with postmyocardial infarction apical VSD underwent hybrid transcatheter repair via subxiphoid surgical access. A transcatheter occluder (Amplatzer Septal Occluder) with a trailing premounted suture was deployed through the right ventricular wall and through the ventricular septum into the left ventricular apex. The trailing suture was used to connect an anchor external to the right ventricular wall. Tension on the suture then collapses the right ventricular free wall against the septum and left ventricular occluder, thereby obliterating the VSD. Outcomes were compared with 9 patients who underwent surgical repair using either patch or primary suture closure.ResultsAll patients had significant left-to-right shunt (Qp:Qs 2.5:1; interquartile range [IQR, 2.1-2.6] hybrid repair versus 2.0:1 [IQR, 2.0-2.5] surgical repair), and elevated right ventricular systolic pressure (62 [IQR, 46-71] versus 49 [IQR, 43-54] mm Hg, respectively). All had severely depressed stroke volume index (22 versus 21 mL/m2) with ≈45% in each group requiring mechanical support preprocedurally. The procedure was done 15 (IQR, 10-50) versus 24 (IQR, 10-134) days postmyocardial infarction, respectively. Both groups of patients underwent repair with technical success and without intraprocedural death. One patient in the hybrid group and 4 in the surgical group developed multiorgan failure. The hybrid group had a higher survival at discharge (86% versus 56%) and at 30 days (71% versus 56%), but similar at 1 year (57% versus 56%). During follow-up, 1 patient in each group required reintervention for residual VSD (hybrid: 9 months versus surgical: 5 days).ConclusionsEarly intervention with a hybrid transcatheter/surgical repair may be a viable alternative to traditional surgery for postinfarction apical VSD.

Dataset Information

Patch exclusion technique with Amplatzer septal occluder device for the treatment of postinfarction ventricular septal defect.

Publications

Patch exclusion technique with Amplatzer septal occluder device for the treatment of postinfarction ventricular septal defect.

Similar Datasets

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