Surgical treatment of left ventricular post-infarction aneurysm with endoventriculoplasty: late clinical and functional results

Objective: The temporal response to endoventriculoplasty (EVP) has not been well defined. We have evaluated the long-term clinical and functional resu lts of this technique. Methods: From 1988 to 1997, 121 patients underwent a neurysmectomy by EVP associated with myocardial revascularization for anter oapical left ventricular postinfarction aneurysm. Among these, 39 patients (43%) underwent early post-operative cardiac catheterization (within 3 mont hs maximum), and were available to be revaluated after a mean follow-up tim e of 56 +/- 28 months, by means of a new hemodynamic study. Left ventricula r silhouettes were analyzed by means of a special software. Results: The me an New York Heart Association functional class decreased from 2.5 +/- 0.9 t o 1.6 +/- 0.8 (P < 0.001) late postoperatively. The global ejection fractio n improved early postoperatively from 43 +/- 13 to 61 +/- 13% (P < 0.001), and late postoperatively slightly decreased to 42 +/- 13% (ns) versus preop erative values. Left ventricular end diastolic pressure early postoperative ly fell from 16.8 +/- 7 to 15.7 +/- 6.7 (ns), and late postoperatively incr eased to 21.6 +/- 8.8 (ns) versus preoperative values. Pulmonary artery pre ssure rose early postoperatively from 31.5 +/- 6.4 to 32.1 +/- 6.7 (ns), an d late postoperatively to 34.9 +/- 8.9 (ns). The global contractility score decreased early postoperatively from 42.3 +/- 9.6 to 28.4 +/- 13.6 (P < 0. 001); the global late postoperative contractily was 35 +/- 14 (ns) versus p reoperative values. Patients who benefit most from the operation were those with a normal postoperative contraction pattern, where ejection fraction i mproved respectively early postoperatively from 43 +/- 13 to 63 +/- 11% (P < 0.001), and late postoperatively to 49 +/- 10% (P < 0.001) versus preoper ative values. Occlusion or critical stenosis of bypass grafts occurred in 1 0 patients (25.6%). There were no significant differences in hemodynamic da ta and hypokinesis score changes between patients with patent or occluded b ypass graft, and between patients with mono or multivessel disease. The ope rative mortality was 6.3%, and 8.8% needed intraaortic balloon counterpulsa tion. The actuarial survival rates at 5 and 7 years were 73 +/- 6 and 61 +/ - 6%. The mean follow-up period was 68 months (with 112 months maximum). Co nclusions: We conclude that, in our patients group, EVP of left ventricular aneurysm associated with coronary grafting improves clinical status after operation. We registered a trend for a mild hemodynamic worsening, irrespec tive of coronary artery disease except in those patients who had shown a no rmal postoperative contraction pattern. (C) 1999 Elsevier Science B.V. All rights reserved.