Closure of multiple ventricular septal defects by the felt sandwich technique: Further analysis of 36 patients

Objectives: We previously described a novel technique for closure of trabecular ventricular septal defects by sandwiching the septum with 2 polyester felt patches without requiring left ventriculotomy. We describe the midterm results of this technique and the postoperative cardiac function. Methods: This is a retrospective study of 36 consecutive patients. The median age and body weight at the time of repair was 15 months ( range: 2-115 months) and 7.8 kg ( range: 3.9-51.9 kg), respectively. Results: Sixty-three trabecular ventricular septal defects in 36 patients were closed with the felt sandwich technique. In the early postoperative period, 1 patient died of pulmonary hypertensive crisis. There were 2 late deaths. One patient died of pneumonia 6 months after surgery, and another died suddenly of ventricular arrhythmias 2 years after surgery. Three patients required reoperation ( closure of major residual ventricular septal defect, cardiac transplantation for dilated cardiomyopathy, and pacemaker implantation for complete atrioventricular block). Postoperative left ventricular fractional shortening in the group with a body surface area less than 0.4 m(2) was significantly lower than that in the group with a body surface area of 0.4 m(2) or greater (0.22 +/- 0.09 vs 0.31 +/- 0.06, P =.0027). Moreover, there was a strong correlation between postoperative left ventricular ejection fraction and total patch area/body surface area ratio (R = - 0.74, P =.0004). Conclusion: Multiple trabecular ventricular septal defects can be closed with the felt sandwich technique easily and safely. Although this technique can be used in small infants, the use of numerous felt patches disturbs the movement of ventricular septum, which may cause postoperative cardiac dysfunction.