Surgical repair of multiple muscular ventricular septal defects: The role of re- endocardialization strategy Bahaaldin Alsoufi, MD, Tara Karamlou, MD,

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Surgical repair of multiple muscular ventricular septal defects: The role of re- endocardialization strategy Bahaaldin Alsoufi, MD, Tara Karamlou, MD, Masaki Osaki, MD, Mitesh V. Badiwala, MD, Chan Chee Ching, MS, Ann Dipchand, MD, Brian W. McCrindle, MD, MPH, John G. Coles, MD, Christopher A. Caldarone, MD, William G. Williams, MD, Glen S. Van Arsdell, MD The Journal of Thoracic and Cardiovascular Surgery Volume 132, Issue 5, Pages 1072-1080.e2 (November 2006) DOI: 10.1016/j.jtcvs.2006.07.011 Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Re-endocardialization strategy relies on double-layer suturing of septal trabeculations to each other with fine, superficial, endocardial running sutures. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1072-1080.e2DOI: (10.1016/j.jtcvs.2006.07.011) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Preoperative example of patient 1 with multiple ventricular septal defects, including perimembranous defect, and multiple muscular defects involving posterior/inlet, midtrabecular, apical, and anterior compartments. B, Complete obliteration of ventricular septum was achieved in patient 1 with patch repair of perimembranous and large inlet muscular defects, with re-endocardialization sutures to obliterate completely remaining defects. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1072-1080.e2DOI: (10.1016/j.jtcvs.2006.07.011) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Preoperative example of patient 2 with multiple ventricular septal defects, including perimembranous defect, and multiple muscular defects involving posterior/inlet, midtrabecular, apical, and anterior compartments. B, Complete obliteration of ventricular septum was achieved in patient 2 with patch repair of perimembranous defect, intraoperative device closure of large apical defect underneath moderator band, and re-endocardialization sutures to obliterate completely remaining defects. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1072-1080.e2DOI: (10.1016/j.jtcvs.2006.07.011) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Kaplan-Meier estimated survival after repair of multiple muscular ventricular septal defects for entire cohort of 116 patients. The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1072-1080.e2DOI: (10.1016/j.jtcvs.2006.07.011) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Risk-adjusted predictions for time-related survival after repair of multiple ventricular septal defects (VSDs) stratified by era of operation. There was significant interaction term whereupon similar of cardiopulmonary bypass (CPB) duration had been neutralized in most recent era. Longer CPB time was a risk-factor in earlier eras, but not within most recent era (Era 3). The Journal of Thoracic and Cardiovascular Surgery 2006 132, 1072-1080.e2DOI: (10.1016/j.jtcvs.2006.07.011) Copyright © 2006 The American Association for Thoracic Surgery Terms and Conditions