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Results after resection of postinfarction left ventricular aneurysms
Insights
Left ventricular aneurysmectomy (LVA) improved symptoms like heart failure and angina in most patients, but functional recovery and arrhythmias remained significant challenges. LVA alone is insufficient for treating life-threatening arrhythmias.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Left ventricular aneurysmectomy (LVA) is a common surgical procedure.
- Late functional and hemodynamic outcomes after LVA require further definition.
Purpose of the Study:
- To evaluate the long-term functional and hemodynamic results of left ventricular aneurysmectomy.
- To assess clinical improvement, exercise capacity, and arrhythmia management post-LVA.
Main Methods:
- Retrospective analysis of 135 patients undergoing LVA between 1969 and 1979.
- Follow-up of 104 hospital survivors (mean 37 months) including clinical assessment, bicycle exercise testing, recatheterization, and long-term ECG monitoring.
Main Results:
- Actuarial 5-year survival rate was 77%. Clinical improvement in heart failure (82%) and angina (70%) was observed.
- Only 30% returned to normal work; 59% had normal exercise capacity. Hemodynamic changes were minimal.
- Ventricular arrhythmias persisted in 70% of patients; LVA alone was insufficient for life-threatening arrhythmias.
Conclusions:
- LVA leads to significant symptomatic and functional improvement but limited hemodynamic and ECG benefits.
- Post-infarct ventricular tachyarrhythmias pose risks and require further investigation and potentially additional surgical interventions.
- Electrophysiologic studies and tailored surgical approaches are necessary for managing arrhythmias in LVA patients.
Abstract:
Although left ventricular aneurysmectomy (LVA) is a common surgical procedure, the late functional and hemodynamic results have not been well defined. This presentation describes our results with LVA in 135 patients operated between 1969 and 1979. Associated procedures were performed in 57 (42%) including coronary bypass grafting in 50, valve replacement in 5, closure of ventricular septal defect in 2, or combinations of these in 3 patients. One hundred four of the 122 hospital survivors were followed from 2 to 107 months (mean = 37 months). There were 13 hospital deaths (9.6%), 12 late deaths (9.8%) and an actuarial 5-year survival rate of 77%. Clinical improvement of preoperative heart failure occurred in 82%, and of angina in 70%. Only 33 patients (30%) returned to normal work. Bicycle exercise testing in 70 patients showed normal working capacity in 41 (59%). Recatheterization in 49 patients showed no significant changes in left ventricular end-diastolic pressure or cardiac index, and a borderline reduction of the total ejection fraction. Ventricular arrhythmias were detected by long-term ECG in 70% of all patients after surgery. Of those with preoperative life-threatening arrhythmias, rhythm improvement was noted in 50%, but only 2 of 13 patients were free of arrhythmias after operation. This study demonstrates a greater frequency of postoperative symptomatic and functional improvement as compared to hemodynamic and ECG improvement. Ventricular tachyarrhythmias originating from post-infarct scars increased intra- and postoperative risk and aneurysmectomy alone is considered insufficient for treatment of these disturbances. Further electrophysiologic investigations are needed and additional surgical measures may be necessary to improve the subset of patients with life-threatening arrhythmias.