Factors influencing better results in operation for postinfarction ventricular aneurysms

A series of 66 consecutive patients operated on for postinfarction ventricular aneurysm is reviewed with regard to the factors influencing the progressive decline of mortality (3.2% in the last 31 patients seen). The method of myocardial protection has a significant influence on mortality, which was 45% in patients operated on with aortic cross-clamping under conventional hypothermia and 5% in patients operated on under profound local hypothermia. Associated revascularization with vein bypass graft was performed in 28 patients, without mortality. The technique of aneurysmectomy adapted to the extension and location of the fibrotic scar is described, with exclusion of the septal portion of the aneurysm in 85% of the patients. In 36 patients who had postoperative cardiac catheterization, this technique produced normal ejection fraction and near normal left ventricular volumes