SURGERY FOR CHRONIC LEFT-VENTRICULAR ANEURYSM - BENEFITS AND SIDE-EFFECTS

Seventy patients who underwent elective resection of symptomatic posti nfarction apico-anterior left ventricular (LV) aneurysm with or withou t coronary revascularization are reviewed. The early (less than or equ al to 30 day) mortality was 5.7%. Mural thrombosis occurred in 29 case s (41.4%), unrelated to the degree of preoperative LV impairment and p redictable from preoperative LV angiography in only seven cases. The r esponse to surgery comprised significant overall improvement of global LV ejection fraction (LVEF) during rest and of all variables in stres s testing. This LVEF recovery correlated significantly with that of pe ak ejections rate, a variable of myocardial contractility. Contrasting ly, right ventricular ejection fraction (RVEF) decreased slightly but significantly without relation to preoperative RVEF or LVEF. In compar isons between patients with congestive heart failure or angina at rest as dominant symptom, the former group showed greater depression of pr eoperative watt and LVEF but better postoperative recovery of these va riables, while right ventricular deterioration was significant only in the latter. Postoperative recovery was best in patients with poor pre operative LV function (LVEF less than or equal to 20%), even when surg ery comprised only aneurysmectomy in isolated but ungraftable LAD dise ase (5 cases). The observed RV deterioration may be 'nonspecific', but it must be kept in mind as a side effect of the operation, as it detr acts unpredictably from postoperative ventricular recovery. Patients w ith well preserved preoperative LVEF, small LV aneurysm and marginal e xpected postaneurysmectomy changes according to LaPlace's law are prob ably at risk, and surgery should then instead be directed towards pres erving the remaining viable myocardium by direct revascularization.