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Left ventricular aneurysm with predominating congestive heart failure. A comparative study of medical and surgical

Y Louagie1, T Alouini, J Lespérance

  • 1Department of Surgery, Montreal Heart Institute, Quebec, Canada.

The Journal of Thoracic and Cardiovascular Surgery
|October 1, 1987
PubMed

Insights

Surgical treatment for postinfarction left ventricular aneurysm improved survival-free complications but not overall survival in heart failure patients. This suggests surgery enhances quality of life and reduces cardiac risks compared to medical management.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Congestive heart failure (CHF) is a common complication of postinfarction left ventricular aneurysm.
  • Patients with this condition often present with severe functional impairment, necessitating effective treatment strategies.

Purpose of the Study:

  • To compare the long-term outcomes of surgical aneurysmectomy versus medical management in patients with CHF due to left ventricular aneurysm.
  • To identify factors influencing survival and cardiac-related complications in this patient cohort.

Main Methods:

  • A retrospective study of 109 patients treated between 1979 and 1985 for CHF caused by left ventricular aneurysm.
  • Patients were divided into two groups: surgical (aneurysmectomy) and medical management.
  • Follow-up averaged 48 months, with outcomes assessed using actuarial survival and complication-free rates.

Main Results:

  • While 5-year survival rates were similar between surgical (70%) and medical (64%) groups, the complication-free rate was significantly higher in the surgical group (52% vs. 31%).
  • Multivariate analysis identified surgical treatment, shorter interval from infarction to diagnosis, and absence of right ventricular failure as predictors of reduced cardiac complications and death.
  • Functional improvement was directly linked to surgical treatment and residual segment contractile score.

Conclusions:

  • Surgical treatment for left ventricular aneurysm in CHF patients improves quality of life and reduces cardiac complications.
  • Surgery does not significantly increase overall survival compared to medical management but offers a better prognosis for cardiac-related events.
  • Key factors for improved outcomes include surgical intervention and timely management post-infarction.

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