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Resection of left ventricular aneurysm. Report of 277 patients
Insights
Surgical resection of left ventricular aneurysm (LVA) combined with coronary artery bypass (CAB) surgery improves patient outcomes. This combined approach, known as a "complete operation," offers better results than LVA resection alone for patients with significant coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Patients with left ventricular aneurysm (LVA) treated medically have a poor prognosis.
- Surgical resection of LVA has been the standard treatment at the Texas Heart Institute since 1958.
- Selective coronary arteriography reveals significant coronary artery disease (CAD) in over 75% of LVA patients.
Purpose of the Study:
- To evaluate the efficacy of combined coronary artery bypass (CAB) and LVA resection.
- To compare outcomes of LVA resection alone versus combined CAB and LVA resection.
Main Methods:
- Retrospective analysis of 277 patients with LVA from 1958 to 1977.
- Group I (1958-1969): 101 patients underwent LVA resection alone.
- Group II (1969-1977): 125 patients underwent combined CAB and LVA resection.
- Group III (1969-1977): 51 patients underwent LVA resection alone due to insignificant CAD.
Main Results:
- Operative mortality was 19.8% in Group I, 12.8% in Group II, and 9.5% in Group III.
- Factors associated with higher mortality included high coronary artery score, left main lesions, posterior/inferior LVA location, mitral insufficiency, and incomplete revascularization.
- Groups II and III demonstrated lower mortality and improved long-term results compared to Group I.
Conclusions:
- Combined CAB and LVA resection ("complete operation") is justified for LVA patients with significant CAD.
- The "complete operation" approach leads to improved long-term outcomes.
- Careful patient selection and surgical technique are crucial for optimizing results in LVA surgery.
Abstract:
The prognosis of patients with LVA (left ventricular aneurysm) treated medically has been uniformly poor. Surgical resection of the ventricular aneurysm has been the treatment of choice at the Texas Heart Institute since 1958. A more accurate evaluation of patients with LVA by selective coronary arteriography has demonstrated significant associated CAD in over 75 percent of these patients. Since 1969, 125 patients with at lease one vessel suitable for bypass (group II) have undergone single, double or triple ACB in association with LVA resection; and 51 patients (group III) without significant conc-omitant CAD underwent LVA resection alone. To evaluate the efficacy of combined ACB and LVA resection, patients in group II and group III were compared to a third group of 101 patients who underwent LVA resection alone from 1958 to 1969 (group I). Operative mortality was higher in group I (19.8%) as compared to group II (12.8%) and group III (9.5%). Higher mortality was found to be related to a coronary artery score above 8.9, presence of left main coronary lesion, posterior or inferior location of the LVA, severe concomitant mitral valve insufficiency and incomplete revascularization of the remaining ventricular myocardium after LVA resection. Lower mortality and improved long-term results found in groups II and III as compared to group I appear to justify our choice of a "complete operation" in patients with LVA.