LONG-TERM RESULTS OF VISUALLY GUIDED LEFT-VENTRICULAR RECONSTRUCTION AS SINGLE THERAPY TO TREAT VENTRICULAR-TACHYCARDIA ASSOCIATED WITH POSTINFARCTION ANTEROSEPTAL ANEURYSM

Introduction: Postinfarction ventricular tachycardia (VT), anterosepta l aneurysm, and ventricular dysfunction are commonly associated and pr edict a poor long-term prognosis. Surgical left ventricular reconstruc tion, which includes double plication of the anterior and septal wall, can improve ventricular function. This article analyzes the long-term efficacy of such a procedure to control recurrence of VT in a group o f 50 consecutive patients. Methods and Results: The study group consis ted of 50 consecutive patients operated on between December 1986 and D ecember 1994. The group comprised 44 men and 6 women. The mean age was 56 +/- 11 years. All patients had spontaneous VT following an anterio r myocardial infarction, Twenty-five patients had two or more episodes of VT (eight presented as cardiac arrest, nine as syncope), Coronary artery disease was limited to the left anterior descending artery in 2 7 patients, An anteroseptal aneurysm was present in 49 patients. All p atients had VT induced by programmed ventricular stimulation before su rgery, and left ventricular reconstruction was performed without intra operative mapping in all cases. Total mortality, VT recurrence, and su dden death rate were the endpoints of the study. In-hospital mortality was 8%. Postoperative left ventricular ejection fraction improved fro m 0.35 to 0.50 (P < 0.05). Only two patients had postoperative inducib le VT. Overall survival, VT recurrence rate, and sudden death rate wer e 73%, 12%, and 10%, respectively, after a median follow-up period of 6.25 years (0 to 8 years). Conclusion: Visually guided left ventricula r reconstruction with septal and anterior wall plicature can be utiliz ed effectively to treat recurrent VT associated with postinfarction an teroseptal aneurysm.