Long-term Results after Reconstructive Surgery for Aneurysms of the Left Ventricle
Background: Aneurysms of the left ventricle (LV) present a serious consequence of myocardial infarction, causing mechanical, thromboembolic, and arythmogenic complications. We present our experience in LV remodeling and long-term follow-up results.
Methods: From May 1998 to February 2009, 85 patients with postinfarction LV aneurysm underwent reconstructive procedures. Mean age was 58.7 ± 8.9 years (range 36-79 years). Average LV ejection fraction was 39.8% ± 13.1% (range 20%-70%). Mean EuroScore was 6.0 ± 2.9 (range 3-19) and predictive mortality was 8.2% ± 11.9% (range 1.6%-85.6%). The majority of patients were in New York Heart Association functional class II (44%) preoperatively and 32% of patients were in New York Heart Association class III or IV. LV reconstruction was performed by using the endoventricular patch technique in 56 patients (66%). In 29 patients (34%) reconstruction was done by linear closure. In 79 patients (93%) concomitant myocardial revascularization was performed. Mitral valve procedures were performed in 11 patients (13%), (repair in 10 patients and replacement in 1).
Results: Perioperative mortality was 3.5% (3 patients). Long-term follow-up was completed by means of phone interview with an average duration of 31.6 months (range 3-120 months). There were 9 late deaths (11%) during follow-up. Actuarial survival rates at 1, 5, and 10 years were 91%, 77%, and 68%, respectively. Fifty-nine patients (72%) were in New York Heart Association functional class I and II postoperatively.
Conclusion: LV remodeling is a safe surgical procedure with low perioperative morbidity and mortality and excellent long-term survival, even in patients with severely reduced systolic function.
Cooley DA, Collins HA, Morris GC Jr, Chapman DW. 1958. Ventricular aneurysm after myocardial infarction; surgical excision with use of temporary cardiopulmonary bypass. J Am Med Assoc 167:557-60.nDi Mattia DG, Di Biasi P, Salati M, Mangini A, Fundarò P, Santoli C. 1999. Surgical treatment of left ventricular post-infarction aneurysm with endoventriculoplasty: late clinical and functional results. Eur J Cardiothorac Surg 15:413-8.nDor V, Saab M, Coste P, 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, Toso A, Maioli M. 1998. Efficacy of endoventricular patch plasty repair 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.nGrondin P, Kretz JG, Bical O, Donzeau-Gouge P, Petitclerc R, Campeau L. 1979. Natural history of saccular aneurysm of the left ventricle. J Thorac Cardiovasc Surg 77:57-64.nKlein P, Bax JJ, Shaw LJ, et al. 2008. Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease. Eur J Cardiothorac Surg 34:1149-57.nLange R, Guenther T, Augustin N, et al. 2005. Absent long-term benefit of patch versus linear reconstruction in left ventricular aneurysm surgery. Ann Thorac Surg 80:537-41.nLundblad R, Abdelnoor M, Svennevig JL. 2003. Repair of left ventricular aneurysm: surgical risk and long-term survival. Ann Thorac Surg 76:719-25.nMatthias Bechtel JF, Tölg R, Graf B, et al. 2004. High incidence of sudden death late after anterior LV-aneurysm repair. Eur J Cardiothorac Surg 25:807-11.nMenicanti L, Di Donato M, Frigiola A, et al. 2002. Ischemic mitral regurgitation: intraventricular papillary muscle imbrication without mitral ring during left ventricular restoration. J Thorac Cardiovasc Surg 123:1041-50.nMenicanti L, DiDonato M, Castelvecchio S, et al. 2004. Functional ischemic mitral regurgitation in anterior ventricular remodeling: results of surgical ventricular restoration with and without mitral repair. Heart Fail Rev 9:317-27.nMickleborough LL, Carson S, Ivanov J. 2001. Repair of dyskinetic or akinetic left ventricular aneurysm: results obtained with a modified linear closure. J Thorac Cardiovasc Surg 121:675-82.nSinatra R, Macrina F, Braccio M, et al. 1997. Left ventricular aneurysmectomy; comparison between two techniques; early and late results. Eur J Cardiothoracic Surgery 12: 291-7.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).