naa a22 4500 510728820 CHVBK 20180411082945.0 cr unu---uuuuu 180411e20131101xx s 000 0 eng 10.1007/s11748-013-0255-z doi (NATIONALLICENCE)springer-10.1007/s11748-013-0255-z Finite element analysis regarding patch size, stiffness, and contact condition to the endocardium in surgery for post infarction ventricular septal rupture [Elektronische Daten] [Toshiaki Ito, Hiroaki Hagiwara, Atsuo Maekawa, Takenori Yamazaki] Background: The purpose of this study is to establish a rational surgical design to minimize suture line stress of the patch and thus prevent residual leakage in surgery for post infarction ventricular septal rupture (VSR). Methods: A computer model that simulates surgery for VSR was developed. Stress force on the suture line of the patch was calculated at varying size, stiffness, and contact condition of the endocardial patch to the inner surface of the heart using a finite element analysis. Clinical results and echo findings of 34 consecutive patients with a mean age of 72.6±9.5 (range 55-89) who underwent emergency surgery for VSR from 1995 to 2012 were reviewed. Results: Suture line stress decreased by two-thirds as the size or stiffness of the patch increased in comparison with the basic conditions that mimic a pericardial patch fitted to the septal plane. On the other hand, suture line stress increased sixfold when there was a dead space beneath the patch. 30-day mortality was 12%, and in-hospital mortality 18%. On echocardiography, all three patients who had dead space beneath the patch had residual leak. Another patient who had huge posterior defect also showed residual leak. Clinical results were well matched to model results. 5-year survival rate of all patients who received operation was 68.7±9.3%. Conclusion: In endocardial patch type surgery for VSR, proper sizing of the patch to sufficiently fit to endocardial surface in a tension-free condition is the most important to avoid residual leak. The Japanese Association for Thoracic Surgery, 2013 Myocardial infarction nationallicence Ventricular septal rupture nationallicence Computer applications nationallicence Ito Toshiaki Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura, 453-8511, Nagoya, Japan aut Hagiwara Hiroaki Department of Cardiovascular Surgery, Kasugai Municipal Hospital, 1-1-1, Takaki-cho, 486-8510, Kasugai, Japan aut Maekawa Atsuo Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura, 453-8511, Nagoya, Japan aut Yamazaki Takenori Department of Cardiovascular Surgery, Kainan Hospital, 396 Minamihonda, Maekasu-cho, 498-8502, Yatomi, Japan aut General Thoracic and Cardiovascular Surgery Springer Japan 61/11(2013-11-01), 632-639 1863-6705 61:11<632 2013 61 11748 https://doi.org/10.1007/s11748-013-0255-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11748-013-0255-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ito Toshiaki Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura, 453-8511, Nagoya, Japan aut NATIONALLICENCE 700 1- Hagiwara Hiroaki Department of Cardiovascular Surgery, Kasugai Municipal Hospital, 1-1-1, Takaki-cho, 486-8510, Kasugai, Japan aut NATIONALLICENCE 700 1- Maekawa Atsuo Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura, 453-8511, Nagoya, Japan aut NATIONALLICENCE 700 1- Yamazaki Takenori Department of Cardiovascular Surgery, Kainan Hospital, 396 Minamihonda, Maekasu-cho, 498-8502, Yatomi, Japan aut NATIONALLICENCE 773 0- General Thoracic and Cardiovascular Surgery Springer Japan 61/11(2013-11-01), 632-639 1863-6705 61:11<632 2013 61 11748 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer