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Resection of left ventricular aneurysm during hypothermic fibrillatory arrest without aortic occlusion
Insights
This study shows ventricular aneurysmectomy during hypothermic fibrillatory arrest without aortic occlusion offers good long-term survival. Grafting coronary arteries with anterior aneurysms improves outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Thoracic Surgery
Background:
- Ventricular aneurysmectomy is a complex procedure for patients with severe heart conditions.
- Traditional methods often involve aortic occlusion, which carries risks.
- Hypothermic fibrillatory arrest without aortic occlusion presents an alternative surgical approach.
Purpose of the Study:
- To evaluate the safety and efficacy of ventricular aneurysmectomy performed during hypothermic fibrillatory arrest without aortic occlusion.
- To assess long-term survival rates and identify predictors of mortality.
- To determine the impact of concomitant coronary artery grafting on outcomes.
Main Methods:
- A consecutive series of 100 patients underwent ventricular aneurysmectomy between December 1977 and September 1984.
- The procedure utilized hypothermic fibrillatory arrest without aortic occlusion.
- Concomitant coronary artery grafting was performed in 97% of patients.
Main Results:
- Hospital mortality was low at 2%, with perioperative myocardial infarction in 1%.
- Actuarial survival at 73 months was 77.0%.
- Grafting of left anterior descending and/or diagonal coronary arteries with anterior aneurysms was associated with improved survival (p < 0.03).
Conclusions:
- Ventricular aneurysmectomy during hypothermic fibrillatory arrest without aortic occlusion is a safe procedure with favorable long-term results.
- Left ventricular ejection fraction and ventricular arrhythmias are predictors of late death.
- Optimal outcomes are achieved when anterior aneurysms are resected with concomitant grafting of relevant coronary arteries.
Abstract:
From December, 1977, through September, 1984, 100 consecutive patients had ventricular aneurysmectomy during hypothermic fibrillatory arrest without aortic occlusion. In the series were 83 men and 17 women, mean age 57.2 years. Primary indications for operation were angina pectoris in 42 patients, congestive heart failure in 23, angina plus congestive failure in 22, and refractory ventricular irritability in 13. Emergency operation was required for 13 patients with an intra-aortic balloon pump. Mean New York Heart Association Class was 3.1. Mean left ventricular end-diastolic pressure was 19.5 mm Hg, and mean left ventricular ejection fraction was 0.37. Concomitant coronary artery grafting was performed in 97 patients (mean 3.2 grafts/patient). Pressor agents were used in 21 patients and an intra-aortic balloon pump in two patients. Perioperative myocardial infarction was documented in one patient (1%). There were two hospital deaths (2%), both in patients with refractory ventricular irritability. At late follow-up (mean 38.5 months), 13 additional patients (13.3%) had died. Actuarial survival rate at 73 months was 77.0%. Survival rate was better for 93 patients with anterior aneurysms if the left anterior descending and/or diagonal coronary arteries were grafted with aneurysmectomy (p less than 0.03). Although only ventricular arrhythmias predicted early death (p less than 0.03), ejection fraction (p less than 0.01) and ventricular arrhythmias (p = 0.03) predicted late death. Ventricular aneurysmectomy during hypothermic fibrillatory arrest without aortic occlusion can be performed with low hospital mortality and good long-term results. When possible, left anterior descending and/or diagonal coronary arteries should be grafted when anterior aneurysms are resected.