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Long-term clinical and hemodynamic studies after ventricular aneurysmectomy and aorta-coronary bypass
Insights
Ventricular aneurysmectomy with aorta-coronary bypass improved cardiac function in most patients, but long-term complications impacted outcomes. This study evaluated clinical and hemodynamic results in 18 patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Heart Aneurysm Treatment
Background:
- Ventricular aneurysmectomy combined with aorta-coronary bypass is a surgical option for patients with significant coronary artery disease.
- Evaluating long-term clinical and hemodynamic outcomes is crucial for understanding the efficacy and limitations of this combined procedure.
Purpose of the Study:
- To assess the late clinical and hemodynamic outcomes of patients who underwent ventricular aneurysmectomy and aorta-coronary bypass.
- To identify factors associated with successful outcomes and postoperative complications.
Main Methods:
- Retrospective analysis of 18 patients undergoing ventricular aneurysmectomy and aorta-coronary bypass.
- Inclusion of clinical evaluations (NYHA classification) and hemodynamic studies (cardiac index, LVEDP).
- Assessment of graft patency and postoperative complications.
Main Results:
- 11 patients (61%) had excellent or good clinical results, with significant increases in cardiac index post-surgery.
- 2 patients with poor outcomes showed elevated LVEDP, low cardiac index, and persistent left ventricular dyskinesia.
- Mortality rate was 17% within one year; complications included embolism, myocardial infarction, and graft occlusion.
Conclusions:
- Ventricular aneurysmectomy with aorta-coronary bypass can lead to significant hemodynamic improvement in selected patients.
- Long-term success is limited by complications such as systemic embolism, graft failure, and disease progression.
- Careful patient selection and management of postoperative complications are essential for optimizing outcomes.
Abstract:
Late clinical and hemodynamic evaluations in 18 patients with ventricular aneurysmectomy and aorta-coronary bypass are presented. Tne patients had significant obstructive lesions in two major vessels (55 per cent), and 6 had extensive three vessel disease (33 per cent). In 13 patients, 21 aorta-coronary saphenous bypass grafts were performed in addition to aneurysmectomy. The operative mortality rate was 11 per cent. One patient died suddenly 5 months after the operation (one year mortality rate 17 per cent). The 15 surviving patients have been followed up for 12 to 41 months (average 24 months). Clinical results were considered excellent in 2 patients who have been asymptomatic (Class I, N.Y.H.A.). Nine others were considered to have good clinical results (Class II). Five patients have continued to have congestive heart failure and angina on minimal effort (Class III or IV). Six of the 11 patients considered to have excellent or good results underwent postoperative hemodynamic studies 6 to 34 months after the operation. A significant increase in cardiac index was documented in all 6 patients. Paradoxic movement was not detected in any of the postoperative ventriculograms. Five of the seven venous grafts inserted were patent. Elevated left ventricular end-diastolic pressure (LVEDP), low cardiac index, and a persistent dyskinetic area in the left ventricle were found in 2 patients considered to have poor clinical results. Clinical and hemodynamic evaluations have shown a significant improvement in most patients surviving ventricular aneurysmectomy. However, postoperative systemic embolism, myocardial infarction, progression of coronary artery disease, transient cerebral ischemic attacks, graft occlusion, arrhythmias, and mitral regurgitation in previously prolapsed mitral valve leaflets account for progressive disability and limited activity after a successful operation.