EARLY AND LATE RESULTS AFTER SURGICAL THERAPY OF POSTINFARCTION LEFT-VENTRICULAR ANEURYSM

From 1979 to 1993, 139 patients had reduction of left ventricular aneu rysm (LVA) by plication (PL) (25 cases) linear repair (74 cases) or ve ntricular reconstruction (VR) (40 cases). Coronary bypass grafting was performed in 89 patients. We retrospectively reviewed our experience in order to identify predictore of early and late outcome and determin e whether ventricular reconstruction (VR) can improve postoperative an d late prognosis. Operative mortality (OM) was 7.2%. Among 129 hospita l survivors, 48 died during FU (LM). OM was related to a more recent m yocardial infarction (p=0.0001), a higher residual score (RS) (p=0.02) , a lower EF (p=0.038), a higher left ventricular score (p=0.059), a t hree-system disease (TSD) (p=0.09) and a right coronary disease (RCD) (p=0.13). At Multivariate Analysis (Stepwise Logistic Regression) TSD (p=0.001), RCD (p=0.008) and RS (p=0.04) are independent risk factors. Actuarial survival rate at 15 years is 33.5+/-6.9% COM included). Acc ording to the comparison of the Actuarial Curves (Tests of Mantel and Breslow, OM excluded) the most significant risk factors were: non use of left internal mammary artery (LIMA) (p=0.004), VR (p=0.01), TSD (p= 0.03) and higher NYHA class (p=0.019). Multivariate Analysis (Co Model ) confirms that late prognosis is influenced by non use of LIMA (p=0.0 3) and TSD (p=0.04); outcome is also affected by preoperative arryhthm ias (p=0.022). Five-year survival after VR is 87.5+/-5.7% vs 64.9+/-5. 5% after simple linear closure or PL (p=0.1075 and p=0.2252). Our resu lts confirm that OM and LM are influenced by extent of myocardial isch emic damage; in agreement with the majority of Authors we advocate a c omplete revascularization using IMA, when appropriate, on left anterio r descending artery. Our limited experience with VR fails to demonstra te this technique as an independent factor of late survival.