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Early and late results after surgical therapy of postinfarction left ventricular aneurysm
S Pasini1, P Gagliardotto, G Punta
1Department of Cardiac Surgery, University of Turin, Italy.
Insights
This study analyzed outcomes for 139 patients undergoing left ventricular aneurysm repair. While operative mortality was 7.2%, long-term survival was influenced by factors like coronary artery disease extent and revascularization strategies.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Aneurysm Repair
Background:
- Left ventricular aneurysm (LVA) poses significant risks, necessitating surgical intervention.
- Surgical techniques for LVA include plication (PL), linear repair, and ventricular reconstruction (VR).
- Understanding predictors of early and late outcomes is crucial for improving patient prognosis.
Purpose of the Study:
- To identify predictors of early and late outcomes after LVA repair.
- To evaluate the impact of ventricular reconstruction (VR) on postoperative and late prognosis.
- To analyze the effectiveness of different surgical techniques and revascularization strategies.
Main Methods:
- Retrospective review of 139 patients undergoing LVA repair between 1979 and 1993.
- Surgical procedures included plication (PL), linear repair, and ventricular reconstruction (VR).
- Coronary bypass grafting was performed in 89 patients; multivariate analysis was used to identify risk factors.
Main Results:
- Operative mortality (OM) was 7.2%. Independent risk factors for OM included three-system disease (TSD), right coronary disease (RCD), and residual score (RS).
- Actuarial survival at 15 years was 33.5% (OM included). Significant risk factors for late mortality included non-use of left internal mammary artery (LIMA), VR, TSD, and higher NYHA class.
- Five-year survival after VR was 87.5% compared to 64.9% after linear closure or PL, though VR was not an independent factor for late survival in this series.
Conclusions:
- Early and late outcomes after LVA repair are influenced by the extent of myocardial ischemic damage.
- Complete revascularization, including the use of IMA for the left anterior descending artery when appropriate, is advocated.
- While VR showed promising short-term survival, its role as an independent predictor of late survival requires further investigation.
Abstract:
From 1979 to 1993, 139 patients had reduction of left ventricular aneurysm (LVA) by plication (PL) (25 cases) linear repair (74 cases) or ventricular reconstruction (VR) (40 cases). Coronary bypass grafting was performed in 89 patients. We retrospectively reviewed our experience in order to identify predictore of early and late outcome and determine whether ventricular reconstruction (VR) can improve postoperative and late prognosis. Operative mortality (OM) was 7.2%. Among 129 hospital survivors, 48 died during FU (LM). OM was related to a more recent myocardial infarction (p=0.0001), a higher residual score (RS) (p=0.02), a lower EF (p=0.038), a higher left ventricular score (p=0.059), a three-system disease (TSD) (p=0.09) and a right coronary disease (RCD) (p=0.13). At Multivariate Analysis (Stepwise Logistic Regression) TSD (p=0.001), RCD (p=0.008) and RS (p=0.04) are independent risk factors. Actuarial survival rate at 15 years is 33.5+/-6.9% (OM included). According to the comparison of the Actuarial Curves (Tests of Mantel and Breslow, OM excluded) the most significant risk factors were: non use of left internal mammary artery (LIMA) (p=0.004), VR (p=0.01), TSD (p=0.03) and higher NYHA class (p=0.019). Multivariate Analysis (Co Model) confirms that late prognosis is influenced by non use of LIMA (p=0.03) and TSD (p=0.04); outcome is also affected by preoperative arrhythmias (p=0.022). Five-year survival after VR is 87.5+/-5.7% vs 64.9+/-5.5% after simple linear closure or PL (p=0.1075 and p=0.2252). Our results confirm that OM and LM are influenced by extent of myocardial ischemic damage; in agreement with the majority of Authors we advocate a complete revascularization using IMA, when appropriate, on left anterior descending artery. Our limited experience with VR fails to demonstrate this technique as an independent factor of late survival.