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Linear repair versus ventricular reconstruction for treatment of left ventricular aneurysm: a 10-year experience
Insights
Surgical repair of left ventricular aneurysm using ventricular reconstruction showed better long-term symptomatic improvement compared to linear repair, despite higher early mortality. Further experience may enhance survival outcomes.
Area of Science:
- Cardiothoracic Surgery
- Cardiac Surgery
- Cardiology
Background:
- Left ventricular aneurysm (LVA) is a serious complication following myocardial infarction.
- Surgical intervention is often necessary to manage LVA and improve cardiac function.
- Comparing different surgical techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate a 10-year surgical experience with left ventricular aneurysms.
- To compare the efficacy of linear repair versus ventricular reconstruction for LVA.
- To analyze postoperative mortality and symptomatic results between the two surgical approaches.
Main Methods:
- Retrospective analysis of patients undergoing LVA repair with coronary artery bypass grafting (CABG) from 1985-1995.
- Two surgical groups: linear repair (Group A, n=51) and ventricular reconstruction with a patch (Group B, n=10).
- Comparison of preoperative characteristics, early/late mortality, and symptomatic outcomes using statistical tests.
Main Results:
- Overall early mortality was 9.8% (Group A: 7.8%, Group B: 20%).
- Late mortality rates were 34.5% overall (Group A: 38.2%, Group B: 12.5%) at a mean follow-up of 58 months.
- Group B (reconstruction) showed significantly better long-term symptomatic improvement (p=0.02) despite higher preoperative risk and longer cross-clamp times.
Conclusions:
- Ventricular reconstruction with a patch improved ventricular function and long-term symptoms in patients with LVA.
- Higher early mortality in the reconstruction group may be linked to preoperative conditions and operative time.
- Further experience with ventricular reconstruction holds promise for improved survival and prognosis in LVA patients.
Objective:
To describe a 10-year experience with surgical treatment of left ventricular aneurysm and compare the results of linear repair and ventricular reconstruction.
Design:
A retrospective data analysis.
Setting:
Department of cardiothoracic surgery.
Patients:
All patients treated with concurrent coronary artery bypass revascularization and surgical repair of ventricular aneurysm from 1985 to 1995.
Methods:
Patients underwent either linear repair after aneurysmectomy (group A; n=51) or reconstruction of the left ventricle using a patch (group B, n=10). Preoperative patient characteristics and postoperative mortality and symptomatic results in the two groups were compared with chi(2) and paired "t"-tests.
Results:
The early mortality rates were 9.8% overall, 7.8%, in group A, and 20% in group B. During a mean follow-up of 58 months, the late mortality rates were 34.5%, 38.2%, and 12.5%. In comparison to patients in group A, those in group B had higher preoperative rates of seriously impaired left ventricular ejection fraction (p=0.01) and pathologic left ventricular end-diastolic pressure (p=0.03) and a prolonged operative aortic cross-clamp time (p=0.04). Early mortality in group B may have been influenced by the initially impaired hemodynamic function and the cross-clamp time. In the longterm, patients in group B had more symptomatic improvement than those in group A (p=0.02).
Conclusions:
Ventricular function in patients with left ventricular aneurysm improved after ventricular reconstruction using a patch. Further experience with this procedure should improve postoperative survival and long-term prognosis.