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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Left ventricular aneurysm repair: early survival
Antonino Roscitano1, Fabio Capuano, Caterina Simon
1Department of Cardiac Surgery, S Andrea Hospital, "La Sapienza" University of Rome, Rome, Italy. aroscitano@katamail.com
Insights
Left ventricular (LV) aneurysm repair combined with myocardial revascularization shows a 98% survival rate. This procedure improves patient symptoms and cardiac function, demonstrating acceptable surgical risk and good early outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Evaluating early survival in patients undergoing left ventricular (LV) repair and myocardial revascularization.
- Assessing the safety and efficacy of combined surgical procedures for LV conditions.
Purpose of the Study:
- To assess the early survival rates and clinical outcomes of patients who underwent left ventricular (LV) aneurysm repair with concomitant myocardial revascularization.
- To analyze the impact of surgical techniques on patient recovery and cardiac function.
Main Methods:
- Retrospective review of 51 patients undergoing LV repair and myocardial revascularization (1998-2003).
- Analysis of various surgical techniques including McCarthy, Jatene-Dor, and Cooley methods.
- Evaluation of preoperative and postoperative cardiac parameters (ejection fraction, chamber dimensions, wall thickness) and clinical outcomes (NYHA class, CCS angina class).
Main Results:
- Overall early mortality was 3.9% (2 patients), with 98% survival at follow-up.
- Significant improvements observed in NYHA functional class (3.3 to 2.0) and CCS angina class (3.4 to 1.9).
- Left ventricular ejection fraction increased from 36.3% to 44.3%, while LV end-diastolic and end-systolic diameters decreased significantly.
Conclusions:
- Left ventricular (LV) aneurysm repair with concomitant myocardial revascularization is associated with acceptable surgical risk.
- The combined procedure demonstrates good early survival rates and significant clinical improvement in patients.
- Surgical intervention effectively enhances cardiac function and alleviates symptoms in patients with LV aneurysms.
Background:
The aim of this study was to evaluate the early survival in patients submitted to left ventricular (LV) repair and concomitant myocardial revascularization.
Methods:
We retrospectively reviewed the records of 51 patients who were submitted to LV repair and concomitant myocardial revascularization between January 1998 and June 2003. Of 51 patients (44 males with a mean age of 60+/-9.2 years, and 7 females with a mean age of 61+/-6.5 years), 29 (56.9 %) were submitted to the McCarthy technique, 16 (31.3 %) to the technique that was described by Jatene and modified by Dor, and 6 (11.8%) to the Cooley technique (linear repair). The mean preoperative LV ejection fraction was 36.5+/-7.7 %, the mean preoperative LV end-diastolic diameter was 61.8+/-3.9 mm, the mean preoperative LV end-systolic diameter was 49.9+/-5.1 mm, the mean preoperative interventricular septal thickness was 9.7+/-1.7 mm, and finally, the mean posterior wall thickness was 8.9+/-1 mm. The mean follow-up was 30.7+/-23.4 months (range 11-82 months).
Results:
One patient died during surgery (1.9%) and one early postoperatively (1.9%). The causes of death were respectively irreversible ventricular fibrillation and low cardiac output syndrome. The overall survival at follow-up was 98% (49 patients). One patient died during follow-up of myocardial infarction. At follow-up, all patients presented with improved clinical symptoms, and had a better mean NYHA functional class with respect to the preoperative value (3.3+/-0.3 vs 2.0+/-0.5, p < 0.05). Besides, the mean CCS angina class decreased in all patients (3.4+/-0.2 vs 1.9+/-0.3, p < 0.05). The average LV ejection fraction increased from 36.3+/-7.7 to 44.3+/-4.9% (p < 0.001), the average LV end-diastolic diameter decreased from 61.7+/-3.9 to 55.5+/-5.6 mm (p < 0.001), and the average LV end-systolic diameter decreased from 49.9+/-5.1 to 40.4+/-5.1 mm (p < 0.001). No statistically significant difference was found between the preoperative and postoperative data regarding the interventricular septal thickness (9.7+/-1.7 vs 10.3+/-1.6 mm, p = NS), and the posterior wall thickness (9.7+/-1 vs 8.8+/-1.3 mm, p = NS).
Conclusions:
LV aneurysm repair and concomitant myocardial revascularization may be performed with an acceptable surgical risk and a good early survival.
