LEFT-VENTRICULAR ANEURYSM REPAIR - AN ASSESSMENT OF SURGICAL-TREATMENT MODALITIES

Objective: Different closure techniques (linear vs. circular), as well as the efficacy of revascularization in the left ventricular aneurysm repair, with regard to immediate and mid-term results, were assessed and factors having influence on the early mortality and morbidity and survival were analyzed. Method: Between January 1991 and November 1996 , 248 patients underwent surgical repair for postischemic left ventric ular aneurysm. A total of 26 of them were female (10.5%). Linear closu re was employed in 121 patients (48.8%) and circular (patch endoaneury smorraphy) closure in 127 (51.2%). Coronary revascularization was adde d in 203 (81.9%) cases. Patients were followed for an average follow-u p time of 39.3 months. Results: Early mortality rate was 6% (15 patien ts). The difference in mortality rate by the repair method was not sta tistically significant (8.3% in the linear closure group and 3.9% in t he circular closure group, P = 0.15). Absence of preoperative angina p ectoris (P = 0.029), dyspnea as the presenting symptom, a preoperative left ventricular segmental wall motion scoring of 14 or greater, a ca rdiopulmonary bypass duration exceeding 2 h (P = 0.004), an aortic cla mping time exceeding 1 h (P = 0.026) were associated with early mortal ity. Concomitant coronary revascularization had no effect on early mor tality. However, low cardiac output state was less frequent in patient s with concomitant coronary revascularization (P = 0.022). Functional status improved in both groups. Follow-up extending to 81st month reve aled no difference in survival between the groups (84% for linear clos ure group and 92% in circular closure group, including operative morta lity, P = 0.12). However, functional status improvement was better in the patients who underwent circular repair (P = 0.0077). Revasculariza tion appeared as having no important influence on both survival and fu nctional status. A preoperative left ventricular segmental wall motion scoring of 14 or greater was associated with a higher incidence of ea rly mortality, low cardiac output syndrome and poor long-term survival . Conclusion: Left ventricular aneurysm repair is an important therape utic intervention and can be performed with reliable results, regardle ss of repair method, either linear or circular. Long term results reve aled better functional status in circular repair group. Concomitant co ronary revascularization reduced the incidence of low cardiac output s tate. Performance of the unaffected regions of myocardium was found to be an important determinant of both early and late outcome. (C) 1998 Elsevier Science B.V.