Surgery for life-threatening ventricular tachyarrhythmias

Area of Science:

• Cardiovascular Surgery
• Cardiac Electrophysiology

Background:

• Left ventricular aneurysmectomy is a surgical procedure to address complications arising from myocardial infarction.
• Refractory ventricular arrhythmias pose a significant threat to patient survival.

Purpose of the Study:

• To evaluate the efficacy and safety of left ventricular aneurysmectomy in patients with refractory ventricular arrhythmias.
• To identify risk factors influencing operative mortality and long-term outcomes.

Main Methods:

• Retrospective analysis of 203 left ventricular aneurysmectomies performed since 1970.
• Inclusion of patients with coronary artery disease, some undergoing concomitant coronary bypass grafting.
• Assessment of operative and late mortality, focusing on risk variables like recent myocardial infarction.

Main Results:

• Overall operative mortality was 18.7% for left ventricular aneurysmectomy and 19.6% for those also undergoing coronary bypass grafting.
• Mortality was significantly higher in patients with recent myocardial infarction (60%) compared to remote infarction (11%).
• Late mortality was 17.9%, with only one sudden death; 11% of long-term survivors experienced recurrent ventricular tachycardia.

Conclusions:

• Left ventricular aneurysmectomy is a viable option for refractory ventricular tachyarrhythmias, offering acceptable operative mortality.
• Optimal outcomes are observed in patients who have survived beyond six weeks post-myocardial infarction.
• Satisfactory long-term clinical results can be achieved without intraoperative epicardial mapping.