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Therapy and results of surgery: requiring infarction complications. An 8-year experience
Abstract:
Among myocardial infarction (MI) secondary complications requiring surgical intervention, the primary sequel is the left ventricular aneurysm (LVA), as a matter of fact, the ventricle septum rupture (VSR) and the moderate to severe ischemic mitral valve regurgitation (IMR) are common as secondary or third follow ones. Between June 1985 and June 1993 in our department, we performed 6418 operations with the support of the heart-lung-machine. This number includes 74 (1.15%) operations of MI complications; 38 interventions because of LVA, 18 operations because of IMR and 18 surgical corrections of VSR. In the great majority of cases a myocardial revascularization was performed simultaneously. Preoperatively the distribution of the whole patient population according to the functional NYHA classification was as follows: NYHA class I: 0, class II: 0, class III: 36 (48.6%), class IV: 27 patients (36.5%) and cardiogenic shock: 11 patients (14.9%). LVA surgery consists in aneurysmectomy and linear closure or endoventricular patch reconstruction, VSR was closed with synthetic patch material and the correction of IMR was performed mainly through partial resection and replacement with a prosthetic valve. Our early mortality was 13.1% for the LVA, 38.8% for the VSR and 11.1% for the IMR patient population, which was congruent with the rates quoted in current literature. The patient follow-up was done within a period of 6 to 90 months after discharge and the available results are very good. Late mortality was 15%. The actuarial survival rat after 7 years was 85% for the LVA, 82% for the VSR and 87% for the IMR patient population.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Surgical repair of myocardial infarction complications like left ventricular aneurysm (LVA), ventricle septum rupture (VSR), and ischemic mitral valve regurgitation (IMR) showed good long-term survival rates. Despite high early mortality for VSR, overall patient outcomes were favorable after 7 years.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Myocardial infarction (MI) can lead to severe complications requiring surgical intervention.
- Left ventricular aneurysm (LVA), ventricle septum rupture (VSR), and ischemic mitral valve regurgitation (IMR) are significant secondary complications of MI.
Purpose of the Study:
- To evaluate the surgical outcomes and long-term survival rates for patients undergoing interventions for MI complications.
- To assess the efficacy of surgical repair for LVA, VSR, and IMR.
Main Methods:
- A retrospective analysis of 74 surgeries for MI complications (LVA, VSR, IMR) performed between 1985 and 1993.
- Surgical techniques included aneurysmectomy, patch reconstruction, synthetic patch closure for VSR, and valve replacement for IMR.
- Simultaneous myocardial revascularization was frequently performed.
Main Results:
- Early mortality rates were 13.1% for LVA, 38.8% for VSR, and 11.1% for IMR.
- Late mortality was 15% over a 6-90 month follow-up period.
- Actuarial survival rates at 7 years were 85% for LVA, 82% for VSR, and 87% for IMR.
Conclusions:
- Surgical correction of MI complications is associated with significant early mortality, particularly for VSR.
- Despite initial risks, long-term survival rates for patients with LVA, VSR, and IMR are favorable.
- Surgical intervention offers a viable treatment option for managing life-threatening post-MI cardiac complications.