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Ventricular aneurysmectomy: indications, operative findings and outcome at a single centre
N J Samani1, A T Mauric, S Nair
1Department of Cardiology, University of Leicester, UK.
Insights
Left ventricular aneurysmectomy improved patient outcomes, with 65% survival at 5 years. The number of prior myocardial infarctions was the key predictor of long-term adverse outcomes after this cardiac surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Thoracic Surgery
Background:
- Left ventricular aneurysms are serious complications of myocardial infarction.
- Symptoms include congestive cardiac failure, ventricular arrhythmias, and systemic embolism.
- Surgical intervention, left ventricular aneurysmectomy, is considered for specific patient groups.
Purpose of the Study:
- To assess the outcomes of left ventricular aneurysmectomy.
- To identify predictors of mortality and long-term adverse events.
- To evaluate the effectiveness of surgical intervention in improving patient quality of life.
Main Methods:
- Retrospective analysis of 120 patients undergoing left ventricular aneurysmectomy between 1980 and 1990.
- Data collected on patient demographics, prior myocardial infarction history, presenting symptoms, surgical procedures, aneurysm characteristics, and perioperative/late outcomes.
- Logistic regression analysis used to identify predictors of adverse long-term outcomes.
Main Results:
- Overall perioperative mortality was 17%, decreasing over the study period.
- Pump failure was the primary cause of perioperative death.
- Late mortality was mainly due to further myocardial infarction; 65% survival at 5 years.
- 81% and 66% of survivors reported improvement at 5 and 8 years, respectively.
- Number of prior myocardial infarctions was the sole predictor of adverse long-term outcome.
Conclusions:
- Left ventricular aneurysmectomy can lead to significant long-term survival and functional improvement.
- Careful patient selection, considering prior myocardial infarction history, is crucial for optimizing outcomes.
- The procedure offers benefits even for patients with angina alone or those undergoing aneurysmectomy alone.
Abstract:
We assessed all patients (n = 120) who underwent left ventricular aneurysmectomy as part of a cardiac surgical procedure at the Groby Road Hospital subregional cardiothoracic centre (1980-1990). Of these, 71% had had only one prior myocardial infarction and 84% had symptoms generally associated with aneurysms (congestive cardiac failure, ventricular arrythmias or systemic embolism). The indication for surgery was a combination of angina and aneurysm-related symptoms in 43%, one or more aneurysm-related symptoms in 35%, and angina alone in 22%. The majority of patients (57%) underwent aneurysmectomy and coronary artery bypass grafting, although 35% underwent aneurysmectomy alone. Most (61%) aneurysms were > 6 cm in size, and 75% were located at the apex of the left ventricle. Forty per cent had a mural thrombus, and there was no relationship between prior warfarin use and occurrence of mural thrombus. Overall perioperative mortality was 17% (20 patients), although mortality halved between the first and second halves of the study period. The main reason for perioperative was pump failure. Seventeen patients died late during follow-up (mean 52.5 months), the main cause being further myocardial infarction. Nevertheless, 65% were still alive at 5 years, and 81% and 66% of survivors were still better than pre-operatively at 5 and 8 years, respectively. Post-operative improvement was equally as good in patients who underwent aneurysmectomy alone, or those operated on for aneurysm-related symptoms, as in the whole group. In logistic regression analysis, the only predictor of adverse long-term outcome was the number of previous myocardial infarctions.(ABSTRACT TRUNCATED AT 250 WORDS)