PERIOPERATIVE AND LONG-TERM RESULTS WITH MAPPING-GUIDED SUBENDOCARDIAL RESECTION AND LEFT-VENTRICULAR ENDOANEURYSMORRHAPHY

Background Surgical ablation of the arrhythmogenic focus in patients w ith life-threatening ventricular tachyarrhythmias can be curative. How ever, the surgical techniques have been plagued by a high perioperativ e mortality rate (averaging approximate to 12%). Reconstruction of the left ventricle may reduce mortality. Methods and Results Reconstructi on of the left ventricle with a pericardial patch, or endoaneurysmorrh aphy, was performed with mapping-guided subendocardial resection for r ecurrent ventricular tachycardia in 25 patients over a 5-year period. Postoperatively, electrophysiological studies were conducted to assess the results of surgery, which were further evaluated during long-term follow-up with survival analyses. The study included 25 patients, 60/-9 years of age, with coronary artery disease, discrete left ventricl e aneurysms, and malignant ventricular tachyarrhythmias. Left ventricu lar ejection fraction was 24+/-6% preoperatively. Left ventricular end ocardial mapping, endocardial resection, and endoaneurysmorrhaphy were performed in all patients. There was no operative or postoperative (3 0-day) mortality. Postoperative ventricular tachycardia was induced in 2 of the 25 patients (8%); left ventricular function increased to 32/-9% (range, 19% to 52%). At a mean follow-up of 37+/-16 months (range , 6 to 65 months), there had been 6 deaths, including 1 sudden cardiac death, 2 congestive heart failure deaths, and 3 noncardiac deaths. An alysis of multiple variables failed to identify predictors of postoper ative inducibility, sudden cardiac death, cardiac death, or total mort ality. Conclusions Endoaneurysmorrhaphy with a pericardial patch combi ned with mapping-guided subendocardial resection frequently cures recu rrent ventricular tachycardia with low operative mortality and improve ment of ventricular function. Long-term follow-up demonstrates low sud den cardiac death rates.