Surgery Strategy
An individualized delayed surgery strategy was adopted in our center. 1)
The hemodynamically unstable patients who showed little response to
mechanical assistance would undergo emergency surgery with no
hesitation; 2) the patients stabilized by mechanical assistance or
vasoactive agent would receive intensive care for at least 28 days
before urgent surgery; 3) those stable patients who had not received
medicine or mechanical assistance would be monitored strictly in
hospital for at least 28 days, and then underwent elective surgery.
In addition to 5 cases of percutaneous septal closure, all the other 107
cases underwent thoracotomy with CPB. Most patients underwent the
classical patch procedure. The left ventricle was incised parallel to 1
or 2 cm away from the anterior or posterior descending artery. Polyester
patches were sutured to the uninfarcted or fibrotic ventricular septal
tissue, as well as to the uninfarcted ventricle anterolateral wall
tissue to isolate the infarcted myocardium from the left ventricle.
The left ventricle incision was
closed by the felt Sandwich method. For details, refer to a previous
report11.