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.