Finite element analysis regarding patch size, stiffness, and contact condition to the endocardium in surgery for post infarction ventricular septal rupture

Abstract

In endocardial patch type surgery for VSR, proper sizing of the patch to sufficiently fit to endocardial surface in a tension-free condition is the most important to avoid residual leak.

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

“…The patch was a composite one in which the blood contact surface was the bovine pericardium and septal sur-face was Dacron, Teflon, and ePTFE attached together by GRF glue or fibrin glue. We observed a major leak when the size discrepancy of the patch and trimmed VSD was < 30 mm 14) ; it was confirmed by mathematical analysis that a smaller size tended to cause the leak by Ito et al 22) .…”

“…3b and 5d). Although we attempted plication of the leak Midterm survival data from our study (13) and other studies (19)(20)(21)(22) are shown.…”

Left ventricular free wall rupture after surgery for ventricular septal rupture

“…[1][2][3][4][5][6] The technique involves either a left ventricular (LV) or right ventricular (RV) incision approach. Hospital mortality has been reported as 17.6%-36.4% for an LV approach, [1][2][3] and 14.3%-20% for an RV approach. 4,6 Recently, an extended sandwich patch technique through an RV incision has been proposed and attracted surgeons' interest.…”

Post infarction ventricular septal rupture: yet hard to treat disease

“…Their 13.6% of in-hospital mortality was striking, therefore, many surgeons adopted this technique and several modifications of this technique were proposed. In the discussion record of meeting presentation of this paper, Daggett mentioned that "I am unable to decide whether the results that Dr. David has been able to We [4] previously reported geometrical property of patch closure of post infarction VSR using finite element analysis. A large patch that closely contact to endocardium of the left ventricle decreased the stress on the suture line.…”

“…Surgical glue may be an answer. Also in left ventricular approach, by gluing felt strips to the epicardium, bleeding from the closure line of the ventricle can be prevented [4]. If sandwich technique is performed as a mirror image through left ventricular approach as Caimmi et al reported [5], placing larger patch on the left ventricular side becomes easier compared with original right ventricular approach.…”