Related Experiment Videos
Left ventricular function after elective aneurysmectomy
Insights
Patients with left ventricular aneurysm (LVA) undergoing coronary artery bypass surgery showed improved exercise capacity post-surgery. However, those with smaller aneurysms and better baseline ejection fraction benefited most, suggesting aneurysmectomy may not be beneficial for stable LVA patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Left ventricular aneurysm (LVA) is a complication of myocardial infarction.
- Surgical management of LVA, particularly in conjunction with coronary artery bypass surgery (CABS), remains debated.
- Hemodynamically stable LVA patients often present with angina pectoris, necessitating revascularization.
Purpose of the Study:
- To evaluate the impact of combined coronary artery bypass surgery and elective aneurysmectomy on left ventricular function and exercise capacity in patients with stable left ventricular aneurysm.
- To identify predictors of improved outcomes after surgical intervention for left ventricular aneurysm.
Main Methods:
- Rest and exercise first-pass radionuclide angiography were performed before and 3 months after surgery in 15 patients (14 men, 1 woman; mean age 54 ± 7 years) with anterior/apical LVA.
- Patients were stratified into two groups based on preoperative left ventricular ejection fraction (LVEF) response to exercise: Group A (≥5% increase) and Group B (<5% increase or decrease).
Main Results:
- Overall, post-surgery, mean LVEF improved significantly with exercise (p<0.004), but resting LVEF did not change. Exercise duration improved (p<0.01).
- Group B patients demonstrated a significant postoperative increase in LVEF with exercise (≥5%), improved exercise capacity (p<0.01), and double product (p<0.03).
- Group A patients showed a postoperative decrease in LVEF with exercise and no improvement in exercise capacity or double product. Group A had lower preoperative LVEF (p<0.01) and larger LVA than Group B.
Conclusions:
- Hemodynamically stable left ventricular aneurysm is not a contraindication for myocardial revascularization.
- Elective aneurysmectomy in conjunction with coronary artery bypass surgery may not benefit all patients with stable LVA, particularly those with lower baseline LVEF and larger aneurysms.
- Patients with stable LVA requiring CABS for angina may not benefit from concomitant aneurysmectomy; focusing on myocardial revascularization appears more advantageous.
Abstract:
Employing rest and exercise first-pass radionuclide angiography before and 3 months after surgery, we studied patients with hemodynamically stable left ventricular aneurysm (LVA) undergoing both coronary artery bypass surgery to relieve angina pectoris and elective aneurysmectomy. There were 15 patients, 14 men and 1 woman with a mean age of 54 +/- 7 years. All patients had anterior and/or apical LVA. After surgery the postexercise mean left ventricular ejection fraction (LVEF) for the whole group improved significantly (p less than 0.004) compared with the preoperative value, but the resting LVEF did not change. The duration of exercise improved (p less than 0.01) after surgery, but not the double product. However, based upon the preoperative LVEF response to exercise, two groups were seen: Group A (n = 5) had greater than or equal to 5% increase in their LVEF with exercise versus Group B (n = 10), who had less than 5% increase or a decrease in their LVEF. Postoperatively, Group A decreased their LVEF with exercise and failed to improve exercise capacity or double product. Postoperatively, Group B increased the LVEF by greater than or equal to 5% as well as increasing exercise capacity (p less than 0.01), and double product (p less than 0.03). Group A had lower preoperative LVEF than Group B (p less than 0.01) and larger LVA. Patients with hemodynamically stable LVA who require coronary artery bypass surgery for angina should not have aneurysmectomy. The presence of hemodynamically stable LVA is not a contraindication to deriving benefit from myocardial revascularization.