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A single center's experience with total arterial revascularization and spiral aneurysmorrhaphy for ischemic cardiac
Ilias P Doulamis1, Despina N Perrea2, George Mastrokostopoulos3
1Laboratory for Experimental Surgery and Surgical Research "N.S Christeas", Athens Medical School, National and Kapodistrian University of Athens, Agiou Thoma Str., 15b, Goudi, 11527, Athens, Greece. doulamis.i@gmail.com.
Insights
Total arterial myocardial revascularization (TAMR) combined with spiral aneurysmorrhaphy is a feasible surgical option for ischemic heart disease. This approach shows acceptable early outcomes, even with complex cases and varying ejection fractions.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Heart Disease Treatment
Background:
- The combination of left ventricular (LV) geometry restoration and coronary artery bypass grafting for ischemic cardiac disease is debated.
- Total arterial myocardial revascularization (TAMR) and spiral aneurysmorrhaphy represent a surgical approach for advanced cardiovascular disease.
Purpose of the Study:
- To evaluate the peri-operative and in-hospital outcomes of TAMR combined with spiral aneurysmorrhaphy.
- To assess the feasibility of this combined procedure in patients with advanced cardiovascular disease and varying ejection fractions.
Main Methods:
- Retrospective analysis of 101 patients undergoing TAMR and spiral aneurysmorrhaphy.
- Spiral aneurysmorrhaphy, a modified linear technique, was used for LV aneurysms < 5 cm.
- Data on peri-operative and in-hospital events were collected and analyzed.
Main Results:
- The study included 87.13% males with a mean age of 63.1 years and a mean pre-operative ejection fraction (EF) of 35.7%.
- An average of 3.23 grafts per patient was used, with an early mortality rate of 6.93%.
- Concomitant valve surgery prolonged operative times and increased complications, while patients with EF 30-50% had shorter ICU and hospital stays compared to those with EF < 30%.
Conclusions:
- TAMR and spiral aneurysmorrhaphy demonstrate feasibility for treating ischemic heart disease, irrespective of ejection fraction or the addition of valve surgery.
- Early outcomes are consistent with existing data, but long-term efficacy requires further investigation through follow-up studies.
Abstract:
The restoration of left ventricular (LV) geometry in combination with coronary artery bypass grafting for the treatment of ischemic cardiac disease remains controversial. We hereby present the experience of our center with total arterial myocardial revascularization (TAMR) and spiral aneurysmorrhaphy for ischemic heart disease. A retrospective analysis of 101 patients with advanced cardiovascular disease who underwent TAMR and spiral aneurysmorrhaphy was performed. Spiral aneurysmorrhaphy is a modification of the linear aneurysmorrhaphy and was applied to patients who had a LV aneurysm with a diameter of less than 5 cm. Peri-operative and in-hospital data were retrieved. The majority of the patients were male (87.13%) with a mean age of 63.1 years. Mean pre-operative ejection fraction (EF) was 35.7% ranging between 20 and 65%. An average of 3.23 grafts was required per patient. Early mortality was 6.93% (one intra-operative and six in-hospital deaths). Addition of concomitant valve surgery was associated with prolonged total operative, cardiopulmonary bypass and cross-clamp time (p < 0.001), increased need for blood (p = 0.012) and plasma (p = 0.038), longer intensive care unit (ICU) stay (p = 0.045) and higher rate of post-operative cerebrovascular accident (p = 0.011). Furthermore, patients with a pre-operative EF between 30 and 50% had a shorter ICU stay (p = 0.045) and LoS (p = 0.029) compared with patients with EF <30%. Early mortality and post-operative complication rates following this combined procedure are in consistency with the relevant available data suggesting its feasibility regardless of the EF or addition of concomitant surgeries. Data from the follow-up of these patients are required to examine the long-term efficacy of this surgical modality.