Pros and cons of surgery of the left ventricular aneurysm--a review

The prognosis for the patient with a left-ventricular aneurysm depends on the size of the aneurysm and the function of the remaining ventricle. Data in the literature suggest a 5-year-survival rate of 70-75% and a hospital mortality rate of 10% for aneurysmectomy with and without any additional aortocoronary bypass surgery. Medical treatment on the other hand is only credited with a markedly lower 5-year-survival rate of 45%. To date the only prospective data have been derived by the CASS Study, where no significant difference (67% for medical treatment, 69% for surgical treatment) was seen in the six-year-survival rate. However, considering only the patients with the combination of 3-vessel disease, coronary insufficiency, angina pectoris, and high age, the survival time after surgical treatment was significantly higher. The indication quoted for aneurysmectomy was angina pectoris in 46% of cases, acute or chronic coronary insufficiency in 33%, ventricular arrhythmias in 14%, and left ventricular thrombi in only 2.5%. The relative value of operative resection among the possible methods of treatment of the ventricular aneurysm is still a matter of controversy: there is a lack of larger-scale prospective studies comparing medical and surgical therapy.