REPAIR OF LEFT-VENTRICULAR ANEURYSM - LONG-TERM RESULTS OF LINEAR REPAIR VERSUS ENDOANEURYSMORRHAPHY

Background. Recently, endoaneurysmorrhaphy has been proposed as a more physiologic repair of postinfarction left ventricular aneurysm than i s linear repair. There are only a few studies comparing the short-term and long-term results of the two techniques. Methods. Clinical outcom es and echocardiographic measurements of left ventricular volume and s phericity in 27 patients who underwent endoaneurysmorrhaphy were compa red with those in 20 patients who had Linear repair. Results. The two groups were matched with respect to age, gender, comorbid risk factors , functional class, urgency of the operation, and concomitant procedur es. Preoperatively, left ventricular ejection fraction was lower in th e endoaneurysmorrhaphy group (0.25 +/- 0.08 versus 0.30 +/- 0.09; p = 0.03). Follow-up was available in 44 patients (94%) and ranged from 2 to 86 months (mean, 41.0 +/- 26.5 months). Thirty-day operative mortal ity, perioperative complications, 5-year survival, and freedom from ca rdiac death were similar. Early postoperative percentage increase in l eft ventricular ejection fraction was greater after endoaneurysmorrhap hy (0.51 +/- 0.64 versus 0.18 +/- 0.48; p = 0.036). Long-term function al improvement was significantly better in the endoaneurysmorrhaphy gr oup: At the time of last follow-up, 88% of patients were in New York H eart Association class I/II, compared with 53% after linear repair (p = 0.01). There were no measurable differences between the groups with respect to left ventricular ejection fraction (0.28 +/- 0.11 versus 0. 27 +/- 0.11; p = 0.90), left ventricular volume (171.6 +/- 59.1 versus 169.9 +/- 54.4 mL; p = 0.94), and sphericity index (0.61 +/- 0.09 ver sus 0.61 +/- 0.12; p = 1.0). Conclusions. Despite having a similar eff ect on left ventricular geometry, endoaneurysmorrhaphy resulted in a g reater increase in postoperative left ventricular ejection fraction an d a substantially improved long-term clinical outcome. (C) 1997 by The Society of Thoracic Surgeons.