ENDOVENTRICULAR PATCH PLASTY IMPROVES RESULTS OF LV ANEURYSMECTOMY

From May 1985 to December 1991 52 patients were operated upon for post ischemic left ventricular aneurysm (LV-A). Between May 1985 and July 1 989 25 patients (group I) with a mean age of 59 (46-72) years underwen t conventional aneurysmectomy with direct closure of the left ventricl e (LV) and a mean of 1.9 (0-3) additional bypass grafts (54% triple-ve ssel disease). The hospital mortality was 8% (2/25) and the late morta lity during a median follow-up time of 34 months was 28% (7/25) with a 4-year survival of 66%. Improvement in the quality of life (NYHA from 2.6 to 2.1, P = 0.078) and global left ventricular ejection fraction (EF) (from 35 to 38%) proved to be unsatisfactory in conjunction with the high late mortality rate. Between August 1989 and December 1991 a prospective series of 27 consecutive patients (group II) with a mean a ge of 61 (45-71) years underwent endoventricular patch plasty guided b y two-dimensional transthoracic echocardiography (TTE) before and afte r surgery. The patch size and position were calculated preoperatively by measuring the distances from the mitral annulus to the infarct area which were reproduced during surgery with a simple ruler. A mean of 2 .1 (0-4) bypass grafts were added with 62% of the patients having trip le-vessel disease and 19% left main stenosis (P = 0.05, group I versus II). All patients have survived to date. One patient had to be exclud ed, giving a median follow-up time of 14 months for 26 patients. At th e 6 months' control, the mean NYHA class was improved from 2.7 to 1.6, (P = 0.0001). The mean EF improved from 35 to 44%, cardiac index (CI) from 2.8 to 3.4 l/min per m2, enddiastolic volume index (EDVI) from 1 22 to 96 ml/m2 and endsystolic volume index (ESVI) from 78 to 55 ml/m2 (all P < 0.001). From this data we conclude that a patient's quality of life as well as global left ventricular performance can be signific antly improved by endoventricular patch reconstruction of the LV geome try. Two-dimensional transthoracic echocardiography is valuable in siz ing and positioning the patch in cases of minor demarcation of the inf arct area.