Surgical Treatment of Left Ventricular Aneurysms: A Comparison of Long-term Follow-up of Left Ventricular Function for Classic Aneurysmectomy and Endoaneurysmorrhaphy Techniques

  • Ozan Erbasan
  • Cengiz Turkay
  • Atalay Mete
  • Mehtap Turkay
  • Ilhan Golbasi
  • Huseyin Yilmaz
  • Ozan Erdem
  • Omer Bayezid

Abstract

Objective: Myocardial infarction may be complicated by the formation of a left ventricular (LV) aneurysm that distorts the normal elliptical geometry of the ventricle to produce a dilated spherical ventricle with limited contractile and filling capacities. One of the consequences is congestive heart failure, which may be refractory to medical therapy and require surgical treatment. The aim of this study was to evaluate LV function in the late term following repair of LV aneurysm.

Methods: Ninety-seven patients underwent repair of postinfarctional LV aneurysms. Sixty-one patients (62.9%) underwent classic aneurysmectomy, and 36 patients (37.1%) had endoaneurysmorrhaphy. The mean age (±SD) of the 87 men (89.7%) and 10 women was 55.98 ± 8.59 years. Coronary surgery was performed in 82 patients (84.5%), with a mean of 1.34 ± 0.77 grafts/patient. The mean preoperative ejection fraction (EF) was 39.74% ± 8.79% (classic, 39.92% ± 8.90%; endoaneurysmorrhaphy, 39.43% ± 8.61%; difference not statistically significant [NS]). Fifty-five patients (56.7%) had angina of Canadian Cardiovascular Society class III to IV (classic, 55.7%; endoaneurysmorrhaphy, 58.3%; NS), 31 patients (31.9%) were in New York Heart Association (NYHA) class III to IV (classic, 31.1%; endoaneurysmorrhaphy, 33.3%; NS), and the mean preoperative NYHA functional class was 2.88 ± 0.74 (classic, 2.83 ± 0.77; endoaneurysmorrhaphy, 2.97 ± 0.71; NS).

Results: The mortality rate at <30 days was 9.8% (n = 6) in the classic aneurysmectomy group and 2.7% (n = 1) in the endoaneurysmorrhaphy group. Long-term follow-up was available for 80 of these patients. During a mean follow-up of 79.3 ± 37.6 months (range, 6-156 months), 14 patients (17.5%) died of a cardiac-related cause (classic, 8 patients [16.6%]; endoaneurysmorrhaphy, 6 patients [18.7%]; NS). The cardiac-related survival rate was 82.5%. In the first year, at 5 years, and at 10 years, the survival rates of the patients who underwent classical aneurysmectomy were 98.8%, 93.5%, and 76.1%, respectively, and the rates for patients who underwent endoaneurysmorrhaphy were 100%, 93.0%, 71.2%, respectively (P = .2). In the follow-up patient population, the mean preoperative EF was 40.21% ± 9.44% in the classic aneurysmectomy group and 39.34% ± 8.61% in the endoaneurysmorrhaphy group. Postoperatively, mean EFs increased to 44.24% ± 9.50% and 43.80% ± 8.81%, respectively, at the last follow-up. NYHA functional class changed from 2.79 ± 0.77 preoperatively to 1.60 ± 0.73 postoperatively in the classic aneurysmectomy group and from 2.97 ± 0.71 preoperatively to 1.34 ± 0.54 postoperatively in the endoaneurysmorrhaphy group. There was no significant difference in hospital readmissions for cardiac causes (classic, 27.1%; endoaneurysmorrhaphy, 31.2%).

Conclusion: LV aneurysm can be repaired with acceptable surgical risk. Surgical treatment of LV aneurysm is associated with an improvement in long-term survival and symptoms.

References

Antunes PE, Silva R, Ferrao de Oliveira J, Antunes MJ. 2005. Left ventricular aneurysms: early and long-term results of two types of repair. Eur J Cardiothorac Surg 27:210-5.\nBartel T, Vanheiden H, Schaar J, Mertzkirch W, Erbel R. 2002. Biomechanical modeling of hemodynamic factors determining bulging of ventricular aneurysms. Ann Thorac Surg 74:1581-8.\nCooley DA, Collins HA, Morris GC, Chapman DW. 1958. Ventricular aneurysm after myocardial infarction; surgical excision with use of temporary cardiopulmonary bypass. JAMA 167:557-60.\nCooley DA, Frazier OH, Duncan JM, Reul JR, Krajcer Z. 1992. Intracavitary repair of ventricular aneurysm and regional dyskinesia. Ann Surg 215:417-24.\nCooley DA, Walker WE. 1980. Surgical treatment of postinfarction ventricular aneurysm: evolution of technique and results in 1533 patients. In: Moran JM, Michaelis LL, eds. Surgery for the complications of myocardial infarction. New York, NY: Grune & Stratton. p 273-87.\nDi Donato M, Barletta G, Maioli M, et al. 1992. Early hemodynamic results of left ventricular reconstructive surgery for anterior wall left ventricular aneurysm. Am J Cardiol 69:886-90.\nDor V, Saab M, Kornaszewska M, Montiglio F. 1989. Left ventricular aneurysm: a new surgical approach. Thorac Cardiovasc Surg 37:11-9.\nDor V, Sabatier M, Di Donato M, Montiglio F, Tosa A, Maioli M. 1998. Efficacy of endoventricular patch plasty in large postinfarction akinetic scar and severe left ventricular dysfunction: comparison with a series of large dyskinetic scars. J Thorac Cardiovasc Surg 116:50-9.\nGrossi EA, Chinitz LA, Galloway AC, et al. 1995. Endoventricular remodeling of left ventricular aneurysm. Functional, clinical, and electrophysiological results. Circulation 92(suppl):II98-100.\nJatene AD. 1985. Left ventricular aneurysmectomy. Resection or reconstruction. J Thorac Cardiovasc Surg 89:321-31.\nKesler KA, Fiore AC, Naunheim KS, et al. 1992. Anterior wall left ventricular aneurysm repair. A comparison of linear versus circular closure. J Thorac Cardiovasc Surg 103:841-8.\nKomeda M, David TE, Malik A, Ivanov J, Sun Z. 1992. Operative risks and long-term results of operation for left ventricular aneurysm. Ann Thorac Surg 53:22-9.\nKrajcer Z, Elayda MA, Cuasay L. 1992. Ventricular endoaneurysmorrhaphy: results of a new operation for repairing left ventricular aneurysms in 100 patients. Tex Heart Inst J 19:42-6.\nLikoff W, Bailey CP. 1955. Ventriculoplasty: excision of myocardial aneurysm; report of a successful case. JAMA 158:915-20.\nLundblad R, Abdelnoor M, Svennevig L. 2003. Repair of left ventricular aneurysm: surgical risk and long-term survival. Ann Thorac Surg 76:719-25.\nMatsumoto M, Watanabe F, Goto A, et al. 1985. Left ventricular aneurysm and the prediction of left ventricular enlargement studied by two-dimensional echocardiography: quantitative assessment of aneurysm size in relation to clinical course. Circulation 72:280-6.\nMills NL, Everson CT, Hockmuth DR. 1993. Technical advances in the treatment of left ventricular aneurysm. Ann Thorac Surg 55:792-800.\nOlearchyk AS, Lemole GM, Spagna PM. 1984. Left ventricular aneurysm. Ten years' experience in surgical treatment of 244 cases. Improved clinical status, hemodynamics, and long-term longevity. J Thorac Cardiovasc Surg 88:544-53.\nParolari A, Naliato M, Loardi C, et al. 2007. Surgery of left ventricular aneurysm: a meta-analysis of early outcomes following different reconstruction techniques. Ann Thorac Surg 83:2009-16.\nShapira OM, Davidoff R, Hilkert RJ, Aldea GS, Fitzgerald CA, Shemin RJ. 1997. Repair of left ventricular aneurysm: long-term results of linear repair versus endoaneurysmorrhaphy. Ann Thorac Surg 63:701-5.\nShaw RC, Ferguson TB, Weldon CS, Connors JP. 1978. Left ventricular aneurysm resection: indications and long-term follow-up. Ann Thorac Surg 25:336-9.\nTavakoli R, Weber A, Brunner H, Pretre R, Turina M. 2001. Is patch remodelling of LV aneurysm superior to linear repair? Final program and book of abstracts of the EACTS/ESTS Joint Meeting 2001; p 268.\n
Published
2009-10-15
How to Cite
Erbasan, O., Turkay, C., Mete, A., Turkay, M., Golbasi, I., Yilmaz, H., Erdem, O., & Bayezid, O. (2009). Surgical Treatment of Left Ventricular Aneurysms: A Comparison of Long-term Follow-up of Left Ventricular Function for Classic Aneurysmectomy and Endoaneurysmorrhaphy Techniques. The Heart Surgery Forum, 12(5), E272-E278. https://doi.org/10.1532/HSF98.20091066
Section
Articles

Most read articles by the same author(s)