Postinfarction Ventricular Septal Defect: Right Ventricular Approach—The Extended “Sandwich” Patch

“Sandwich Technique” via a Right Ventricle Incision to Repair Postinfarction Ventricular Septal Defects

“…Our in vitro test indicated that a 10:1 volume ratio of adhesive to hardener provides the best force and minimal residual aldehyde . Surgical adhesives other than GRF glue have been used in the sandwich technique via the RV approach . The fourth concern is widespread necrosis at the anterior, posterior, and apical rim of the septal defect that leads to a shortage of viable septal wall upon which to place the suture.…”

“…8 Surgical adhesives other than GRF glue have been used in the sandwich technique via the RV approach. 9 The fourth concern is widespread necrosis at the anterior, posterior, and apical rim of the septal defect that leads to a shortage of viable septal wall upon which to place the suture. In such a case, we must put Hospital mortality include mortality in the transferred hospital up to six months after the surgery.…”

Surgical Repair of Postinfarction Ventricular Septal Defects^|^mdash;2013 Update

“…In the past several decades, several approaches have been developed to improve treatment outcome. Such approaches are infarctectomy and closure, [10][11][12] infarct exclusion, [13][14][15][16] use of surgical glue, 17,18) using an additional patch for infarct exclusion, 19,20) septal exclusion, 21,22) sandwich technique, [23][24][25][26][27] and percutaneous approach. 28) …”

“…34,38) Patients who are in an intermediate position between shock and a stable condition should be operated on promptly (usually within 12 to 24 hours), after an appropriate preoperative evaluation. Prolonged intraaortic balloon pump support before surgery may be beneficial in select patients; 35,39) however, for most patients in an acute clinical setting, recent improvements in surgical techniques [17][18][19][20][21][22][23][24][25][26][27] has enabled rapid surgery in which the advantage of reducing the risk of hemodynamic deterioration seems to exceed disadvantage of surgical difficulty.…”

“…18,45,46) BioGlue (Cryolife Inc., Kennesaw, Georgia, USA) has been recently used to seal a VSD defect. 27,47) Since the ratio of the adhesive and the hardener is mostly controlled by the applicator, BioGlue may solve the problem of residual aldehyde; however, the long-term result is not fully clear.…”