Geometric endo-ventricular patch repair of inferior left ventricular scarsimproves mitral regurgitation and clinical outcome

Background. The surgical reconstruction of inferior left ventricular (LV) a neurysms and scars has been considered a difficult procedure and there has been little material published about this treatment option. In this study w e report on our experience with reconstruction of the inferior wall and com pare it to the outcome of anterior LV reconstructions. Methods. Seventeen patients (group 1) underwent geometric endo-ventricular patch repair (GER) of inferior LV aneurysms and dyskinetic scars between Ja nuary 1998 and December 2000. In addition to poor LV function, 5 of these p atients had severe mitral valve regurgitation (MR), 8 had moderate MR, and 4 had mild MR preoperatively. These patients also underwent coronary artery bypass graft surgery or valve surgery. The perioperative course, survival, and clinical status were evaluated in this group and was compared to those of 86 patients (group 2) undergoing anterior GER during the same period. Results. There was 1 early death in group 1 (5.8%) and 6 in group 2 (7%) (p = ns). At the conclusion of the operative procedure, all patients in group 1 were weaned off cardiopulmonary bypass with trivial to mild MR. There wa s 1 late death in group 1 (6.2%) and 2 in group 2 (2.8%) (p = ns). Eleven p atients (73%) in group I were in New York Heart Association class 1 compare d to 60 in group 2 (77%) (p = ns). Follow-up echocardiography showed that 8 0% of patients in group 1 had trivial MR. Conclusions. The surgical reconstruction of inferior LV aneurysms and scars can be performed safely with the expectation of a reasonable early outcome similar to that achieved with anterior LV scars. When used in this setting GER improves MR, reducing the likelihood of heart failure decompensation. (C) 2001 by The Society of Thoracic Sur-eons.