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The Annals of Thoracic Surgery, Vol 53, 22-28, Copyright © 1992 by The Society of Thoracic Surgeons
M Komeda, TE David, A Malik, J Ivanov and Z Sun
A review of 336 consecutive patients who underwent repair of left
ventricular aneurysm from 1978 to 1989 disclosed that partial resection of
the aneurysm and conventional closure of the ventriculotomy was performed
in 281 patients, inverted T closure in 17, and endocardial patch in 38.
These two latter techniques were developed in an attempt to restore normal
left ventricular geometry. The operative mortality was 6.8% (23 patients).
A stepwise logistic regression analysis of various preopeative clinical,
hemodynamic, and angiographic variables revealed that left ventricular
ejection fraction of 0.20 or less, age greater than 60 years, previous
myocardial revascularization, lack of angina, and New York Heart
Association functional class IV were independent predictors of operative
mortality. The technique of repair was not a predictor of outcome, but when
patients with poor left ventricular function were analyzed separately, the
operative mortality was reduced from 12.5% to 6.5% when newer techniques
were employed. Patients were followed up during a mean of 6.3 years. There
have been 51 late deaths, 45 cardiac. Cox regression analysis indicated
that poor left ventricular function and left main coronary artery stenosis
were the only two predictors of late mortality. The actuarial survival at
10 years was 63% +/- 4%. Most patients (88%) are in New York Heart
Association class I or II. These data indicate excellent long-term results
after repair of left ventricular aneurysm. Newer techniques of repair are
valuable in patients with poor left ventricular function.
ARTICLES
Operative risks and long-term results of operation for left ventricular aneurysm
Division of Cardiovascular Surgery, Toronto Hospital, Western Division, Ontario, Canada.
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