LEFT-VENTRICULAR ANEURYSMECTOMY - COMPARISON BETWEEN 2 TECHNIQUES - EARLY AND LATE RESULTS

Objective: The aim of the present study was to evaluate early and late results of two different surgical techniques for left ventricular ane urysms repair. The conventional aneurysmectomy and direct closure of t he ventricular wall and the endoventricular patch plasty. Methods: We retrospectively reviewed 118 patients operated on for postinfarction l eft ventricular aneurysm from 1981 to 1994. Eighty-seven patients (Gro up A) were operated upon between 1981 and 1991 with the conventional t echnique and 31 patients (Group B) between 1992 and 1994 with the endo ventricular patch plasty technique. Preoperative clinical, hemodynamic and echocardiographic evaluation with operative procedures and early postoperative results of all patients are reported. We also analyzed r esults of late clinical and echocardiographic controls of 34 patients of Group A and all patients of Group B after a mean follow-up of 42 an d 28 months, respectively. Results: Mean number of by-pass grafts was 1.9 in Group A and 2.6 in Group B (P = 0.01). The left anterior descen ding coronary artery was revascularized in 27 patients of Group A (34. 6%) and 26 of Group B (89.7%) (P < 0.001); the left internal mammary a rtery was used in seven patients of Group A (8.9%) and 24 of Group B ( 82.8%) (P < 0.001). Hospital mortality in Group A was 10.3% (9/87), in Group B there was no hospital mortality (P > 0.05). Thirty-two patien ts of Group A (36.8%) and 3 of Group B (9.7%) suffered of low cardiac output syndrome (P = 0.01). At late control, improvements observed in NYHA and CCS classes, left ventricular ejection fraction (all P < 0.00 1 in both groups versus preoperative values) and left ventricular end- diastolic diameter (P > 0.05 in Group A and P < 0.001 in Group B) prov ed to be statistically higher in patients of Group B. Conclusions: End oventricular patch plasty associated with a complete myocardial revasc ularization, in particular of the anterior descending coronary, and a larger use of the internal mammary artery, permits, by means of recons truction of the left ventricular geometry, a better outcome for patien ts undergoing left ventricular aneurysmectomy. (C) 1997 Elsevier Scien ce B.V.