CONGRESS ABSTRACT

Objective: To evaluate the safety and efficacy and report the early multicentre experience of an innovative surgical technique for post-infarction ventricular septal defect (MI-VSD) closure using two hand-made composite patches (two Teflon layers and one pericardial layer sewed together) parachuted through a transversal aortotomy and a right atriotomy, without left ventriculotomy. Methods: Multi-centre retrospective observational study of patients with MI-VSD who underwent surgical repair with this new technique from September 2022 to May 2024. Results: 11 patients – in 8 different hospital institutions – underwent MI-VSD-closure with this new surgical technique. Mean age was 65±9.8yo and 36% were male. 91% had a postero-basal MI-VSD (Ø: 16.7±5.0 mm), due to acute right coronary vessel occlusion, and presented with cardiogenic shock; 10 patients needed preoperatively IABP or ECMO support. Urgent surgery (<48 hours from presentation) was performed in 6 patients. CPB (84±23.9 min) and X-clamp (60.9±20.2 min) times in isolated MI-VSD-repair were short – even without experience with the technique -. There were no major postoperative complications, including intra-operative mortality, peri-procedural stroke, renal failure requiring permanent dialysis, except for three surgical revisions for bleeding. Overall survival was 55% (6 patients); the main cause of death was cardiac shock due to extremely poor bi-ventricular function. Residual MI-VSD was present in one case (which underwent percutaneous closure with Amplatzer). Mean discharge time was 13±7.6 days after surgery. Follow-up ranged from 4-20 (mean 8.5±6.1) months: all patients were alive with improved hemodynamics. Echo findings: ejection fraction 49.3±5.6%, no residual MI-VSD and absence of mitral or tricuspid regurgitation due to patch interference. Conclusions: This technique is feasible, safe, simple, and provides good short-term results, in all type of VSD, especially postero-basal ones. Moreover, ventriculotomy is not needed. In early surgery (≤48h), this technique overcomes the problem of how to deal with frail necrotic tissue, saving time before ventricular and organ failure worsens, that are the two most relevant prognostic factors, along with myocardial infarction extension. It could be the first-line approach, and, in case of significant residual shunt, it can be quickly repeated or it can be eventually integrated by a percutaneous closure in a hybrid strategy