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[Surgical treatment of aneurysm of the left ventricle. Prognostic considerations]
Insights
Surgical resection of cardiac aneurysms offers significant survival benefits, with two-thirds of survivors experiencing excellent or good outcomes. Key surgical indications and contraindications are identified based on left ventricular function and coronary artery disease extent.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Aneurysm Resection
Context:
- 174 cardiac aneurysms were resected between 1970 and 1977.
- 49 patients underwent simultaneous revascularization of the remaining contractile segment.
Purpose:
- To evaluate the outcomes and identify indications/contraindications for cardiac aneurysm resection.
- To assess survival rates, functional status, and symptom relief post-surgery.
Summary:
- Hospital mortality was 10.3%, with a 14% late mortality. Cumulative survival rates were 90% at 3 years and 80% at 5 years.
- Two-thirds of survivors had excellent or good results, with significant improvements in angina pectoris and cardiac rhythm disturbances.
- Surgical indications include >20% left ventricular muscle affected, ejection fraction >10% (single vessel) or >30% (multiple vessels).
- Contraindications include diffuse coronary heart disease, ejection fraction <30%, reduced septal contractility, and general surgical risks.
Impact:
- Establishes criteria for selecting patients for cardiac aneurysm resection.
- Demonstrates the long-term survival benefits and functional improvements achievable with this surgical procedure.
- Provides valuable data for clinical decision-making in managing cardiac aneurysms.
Abstract:
174 cardiac aneurysms were resected between 1970 and 1977. In 49 patients the remaining contractile segment was revascularised at the same time. The hospital mortality was 10.3%, the late mortality was 14%. The uncorrected cumulative survival rate calculated by the actuarial method was 90% at 3 years (84--96), and 80% at 5 years (74--85). Results were excellent or good in two thirds of the survivors; 44% were free of angina pectoris, 40% were improved, 73% had no disturbances of cardiac rhythm, and in 15% they were improved. Comparison of the pre- and post-operative ejection fraction showed that the indication for surgery of a cardiac aneurysm exists when more than 20% of the musculature of the left ventricle is affected, when the total ejection fraction is larger than 10% when one vessel is affected, and more than 30% when more than one vessel is affected. Contraindications are diffuse coronary heart disease, when ejection fraction of the contractile segment is less than 30%, reduction in contractility of the ventricular septum, and the generally applicable surgical contraindications.