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Thorac Cardiovasc Surg 1985; 33(2): 86-93
DOI: 10.1055/s-2007-1014094
© Georg Thieme Verlag Stuttgart · New York

Surgical Treatment of the Post-infarction Left Ventricular Aneurysm. Factors Influencing Early and Late Results

J. M. Gonzalez-Santos, K. Ennabli, M. Galinanes, X. Bosch, J. Lesperance, L. C. Pelletier
  • Department of Cardiovascular Surgery, Montréal Heart Institute, Montréal, Quebéc, Canada
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Publication History

1985

Publication Date:
19 March 2008 (online)

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Summary

The early and late results of a 4 year surgical experience with 119 left ventricular aneurysms (LVA) are analyzed. The most common indication for surgery was angina in 78 patients, congestive heart failure (CHF) in 34, arrhythmia in 5 and recurrent erhbolism in 1. One patient was operated on prophylactically. There were 112 “anterior” and 7 “posterior” aneurysms. Preoperative ventricular function was significantly worse in the CHF group. LVA resection was carried out in 105 patients and a plicature in other 14. In 92 cases the procedure was combined with a myocardial revascularization. Additional cardiac procedures were performed in 14 patients. Overall early (5.9%) and late mortality (18.7 %) was significantly higher in the CHF group than in the angina group (14.7 % versus 1.3 %, p < 0.01, and 37.9 % versus 12.9 %, p < 0.01, respectively). Associated surgical procedures (p < 0.001) and acuity of the LVA (p < 0.05) also increased the operative risk. The 5 year-surival was better for the angina group (85.7 ±4%) and arrhythmias group (80 ± 22%) than for CHF patients (46.7 ± 19 %) (p = 0.052). Functional improvement was uniform between survivors of all groups (73.2 %). In 15 patients with pre- and postoperative studies hemodynamic Parameters were found improved although only a gobal contractile score did reach significant levels (p < 0.005). Several variables were analyzed for their influence on postoperative outcome: Preoperative CHF (p < 0.01), severe mitral incompetence (p < 0.05), size of the aneurysm (p<0.05), ventricular volume (p< 0.025), global ejection fraction (p<0.005), corrected contractile score (p<0.025), pre-and post-angiographic left ventricular end diastolic pressure (p < 0.05 and p < 0.01) and postoperative low cardiac Output (p < 0.05). All these Parameters were significantly related with long-term risk. We conclude that patients presenting with LVA form a heterogenous Population where risk factors influencing early and late results can be identified.

Key words

Ventricular aneurysm - Surgical treatment - Operative risk - Long-term results

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