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René Prêtre
Qing Ye
Marko I. Turina
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Ann Thorac Surg 1999;68:2152-2157
© 1999 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Surgical repair of postinfarction structural failure of the posterobasal part of the heart

René Prêtre, MDa, Nicole Stalder, MDa, Qing Ye, MDa, Jurg Grünenfelder, MDa, Rolf Jenni, MDb, Marko I. Turina, MDa

a Departments of Department of Cardiovascular Surgery, Zürich, Switzerland
b Department of Cardiology, University Hospital, Zürich, Switzerland

Address reprint requests to Dr Prêtre, Klinik für Herzgefässchirurgie, Universitätsspital, 100 Rämistrasse, 8091 Zürich, Switzerland
e-mail: rene.pretre{at}chi.usz.ch

Background. This study is an analysis of our results with endoventricular repair of postinfarction structural defects of the posterobasal part of the heart.

Methods. Thirty-four patients who underwent endoventricular repair of a postinfarction structural defect of the posterobasal heart were reviewed. Patients with rupture of the ventricular septum (18 patients) or free wall (1 patient) were operated on acutely and patients with ventricular aneurysm (15 patients) electively. Restitution of the ventricular geometry was achieved by evertion (11 patients), resection (4 patients), or augmentation of the ventriculotomy (4 patients) in patients with ventricular rupture, and by resection of the aneurysm in the others. Coronary artery bypass was performed in 24 patients.

Results. Six patients died postoperatively (five due to rupture and one from aneurysm) and nine patients (six due to rupture and three from aneurysm) during follow-up. Survival rate at 5 years (including operative mortality) was 43% for patients with rupture and 61% for patients with aneurysm. The majority of the survivors were in New York Heart Association functional class I or II after a median follow-up of 5 years.

Conclusions. Endocardial repair, ventricular remodeling, and selective myocardial revascularization provided overall good results in the treatment of this difficult cardiac area.




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