SURGICAL-TREATMENT OF LEFT-VENTRICULAR AN EURYSMS - IMMEDIATE AND LONG-TERM RESULTS BASED ON A CONSECUTIVE SERIES OF 121 CASES

From 1978 to 1992, 121 cases of postinfarction left ventricular aneury sm (99 males, 22 females, mean ape 60 years) were operated on. The aut hors insist on a high rate of clinical arhythmogenicity (31.4%) and as sociated mechanical complications (21%). 76% of patients were in funct ional NYHA class III or IV. Resection was performed in 90% of patients , plication in 10%. 58% underwent coronary artery bypass grafting (1.7 graft/patient), 16% encircling ventriculotomy, 8% mitral valve replac ement and 13% closure of ventricular septal defect. Operative mortalit y was 14.9% (10% when other mechanical complications where excluded). 5-year survival is 67.9%. Late cardiac deaths are as follow : left ven tricular failure (1.8% A/P), Sudden death (1.4% FLIP), Myocardial infa rction (0.6% A/P). 82% of survivals are in functional NYHA class I or II. Only functional class NYHA III or IV is predictive of late death. We conclude that postinfarction left ventricular aneurysm remains a hi gh risk complication especially when associated with other mechanical complications. When arhythmogenicity is present we suggest rhythmologi c surgery and in all cases, complete revascularization.