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Evaluating candidates for ventricular aneurysmectomy
Insights
Left ventricular (LV) aneurysmectomy risk is best predicted by the modified contractile segment ejection fraction (MCSEF). An MCSEF of 45% or higher indicates a low-risk procedure with sustained symptom relief for patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Infarction Management
Background:
- Left ventricular (LV) aneurysmectomy is a surgical procedure to address complications following myocardial infarction.
- Identifying reliable predictors of surgical risk is crucial for patient selection and improving outcomes.
Purpose of the Study:
- To evaluate surgical risk predictors for patients undergoing left ventricular aneurysmectomy.
- To assess the impact of the modified contractile segment ejection fraction (MCSEF) on operative mortality and long-term outcomes.
Main Methods:
- Prospective evaluation of 40 consecutive patients undergoing LV aneurysmectomy.
- Assessment of various clinical and echocardiographic parameters, including MCSEF.
- 100% follow-up to determine perioperative and late mortality, and symptom improvement.
Main Results:
- Operative mortality was significantly lower (3.4%) in patients with MCSEF >= 45% compared to those with MCSEF < 45% (37.5%, P < .05).
- MCSEF was the primary predictor of mortality, independent of other evaluated factors.
- Survivors experienced significant symptom improvement (1.6 NYHA class) and 44% returned to work.
Conclusions:
- The MCSEF is a critical determinant of surgical risk for LV aneurysmectomy.
- LV aneurysmectomy is a low-risk procedure for patients with MCSEF >= 45%.
- The procedure offers sustained symptom relief and functional recovery for most patients.
Abstract:
Forty consecutive patients having left ventricular (LV) aneurysmectomy were evaluated for surgical risk predictors and were then followed up after operation. Factors evaluated included age, time since last myocardial infarction, NYHA classification, principal indication for surgery, LV end diastolic pressure, LV "A" wave size, number of coronary systems with greater than 70% stenosis, number of coronary bypass grafts, location of aneurysm, and ejection fraction of the nonaneurysmal or "contractile segment," determined by a modification of the method of Watson et al (MCSEF). There was 100% follow-up. There were four perioperative deaths and two late deaths. Operative mortality was 3.4% in patients with MCSEF greater than or equal to 45% and 37.5% in patients with MCSEF less than 45% (P less than .05). None of the other factors evaluated significantly affected mortality independent of MCSEF. Survivors had a mean follow-up of 22 months with a mean improvement in symptoms of 1.6 NYHA class (from 3.3 to 1.7). Forty-four percent have returned to their previous occupations. It is concluded that: (1) the MCSEF is of prime importance in evaluating risk for LV aneurysmectomy; (2) for patients with MCSEF greater than or equal to 45%, LV aneurysmectomy is a low-risk procedure; and (3) LV aneurysmectomy results in sustained relief of symptoms in most patients.