Left ventricle remodelling by double-patch sandwich technique
| Autor: | Mario Zogno, Andrea Nocchi, N. Pederzolli, Vinicio Fiorani, Ernesto Tappainer, Jacopo Manfredi |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Heart Ventricles lcsh:Surgery Myocardial Infarction lcsh:RD78.3-87.3 Cohort Studies Suture (anatomy) medicine Humans Interventricular septum Heart Aneurysm Ventricular remodeling Sandwich technique Aged Retrospective Studies Ejection fraction Ventricular Remodeling Polyethylene Terephthalates business.industry Suture Techniques lcsh:RD1-811 General Medicine Anatomy Middle Aged Surgical Mesh medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Left Ventricular Aneurysm lcsh:Anesthesiology Ventricle Female Cardiology and Cardiovascular Medicine business Research Article |
| Zdroj: | Journal of Cardiothoracic Surgery Journal of Cardiothoracic Surgery, Vol 2, Iss 1, p 10 (2007) |
| ISSN: | 1749-8090 |
| DOI: | 10.1186/1749-8090-2-10 |
| Popis: | Background The sandwich double-patch technique was adopted as an alternative method for reconstruction of the left ventricle after excision of postinfarction dysfunctional myocardium to solve technical problems due to the thick edges of the ventricular wall. Methods Over a 5-year period, 12 of 21 patients with postinfarction antero-apical left ventricular aneurysm had thick wall edges after wall excision. It was due to akinetic muscular thick tissue in 6 cases, while in the other 6 with classic fibrous aneurysm, thick edges remained after the cut of the border zone. The ventricular opening was sandwiched between two patches and this is a technique which is currently used for the treatment of the interventricular septum rupture. In our patients the patches are much smaller than the removed aneurysm and they were sutured simply by a single row of single stitches. However, in contrast to interventricular septum rupture where the patches loosen the tension of the tissues, in our patients the patches pull strongly and restrain the walls by fastening their edges and supporting tight stitches. In this way they could narrow the cavity and close the ventricle. Results The resected area varied from 5 × 4 to 8 × 8 cm. Excision was extended into the interventricular septum in 5 patients, thus opening the right ventricle. CABG was performed on all patients but two. Left ventricular volumes and the ejection fraction changed significantly: end-systolic volume 93.5 ± 12.4 to 57.8 ± 8.9 ml, p < 0.001; end-diastolic volume 157.2 ± 16.7 to 115.3 ± 14.9 ml, p < 0.001; ejection fraction 40.3 ± 4.2 to 49.5 ± 5.7%, p < 0.001. All patients did well. One patient suffered from bleeding, which was not from the wall suture, and another had a left arm paresis. The post-operative hospital stay was 5 to 30 days with a mean 10.5 ± 7.5 days/patient. At follow-up, 9 to 60 months mean 34, all patients were symptom-free. NYHA class 2.5 ± 0.8 changed to 1.2 ± 0.4, p < 0.001. Conclusion The double-patch sandwich technique (bi-patch closure) offers some advantages and does not result in increased morbidity and mortality. In the case of excising a left ventricular aneurysm, this technique in no way requires eversion of the edges, felt strips, buttressed and multiple sutures, all of which are needed for longitudinal linear closure. Moreover, it does not require purse string sutures, endocardial scar remnant to secure the patch or folding the excluded non-functional tissue, all of which are needed for endoventricular patch repair. |
| Databáze: | OpenAIRE |
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