[Post-infarction aneurysm of the left ventricle. Pre-operative parameters conditioning the surgical risk and remote...

83 patients who underwent resection of postinfarction aneurysms involving the anterior wall of the left ventricle were studied to identify possible determinants of operative outcome, long-term survival and long-term improvement. The indications for aneurysmectomy (either isolated or combined with direct revascularization) were congestive heart failure, angina or life-threatening arrhythmias; six patients were asymptomatic at the time of surgery. Operative mortality rate was 14.4% (11.5% for patients operated more than 60 days following myocardial infarction). The over-all survival rate, at a mean follow-up of 31.5 months (range 2 to 82 months), was 74.39%; 80.88% of patient discharged from hospital, exhibited clinical improvement. Mean values of ejection fraction and excess ejection fraction were significantly higher in the group of operative survivors (31.28 +/- 8.26% and 0.17 +/- 0.08 respectively) than those of surgical deaths (20.25 +/- 8.37% and 0.08 +/- 0.06) (p less than 0.005); the coronary score was significantly lower in the group of survivors (6.81 +/- 2.35 vs 8.33 +/- 2.29) (p less than 0.025). Presence of arrhythmias increased operative mortality (33.3% vs 11.2%, p = 0.05), as did a low cardiac output, impaired contraction of the postero-lateral wall and mitral regurgitation. Long-term survival and improvement were not related to anyone of preoperative parameters taken into consideration: however, a higher percentage of clinical improvement was observed when myocardial revascularization was associated to aneurysmectomy (85% vs. 67.7%).