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Left ventricular function after elective aneurysmectomy.

F J Lumia, S Makam, R M MacMillan

    Clinical Cardiology
    |July 1, 1985
    PubMed
    Summary
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    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.

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  • 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.