Article

Endoaneurysmorrhaphy for left ventricular aneurysm: Follow-up in 69 patients

Department of Cardiovascular Surgery, Ege University Medical Faculty, Izmir, Turkey.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital (Impact Factor: 0.65). 02/1996; 23(3):207-10.
Source: PubMed
ABSTRACT
We reviewed the cases of 69 consecutive patients who underwent physiologic reconstruction of the left ventricular cavity with an endoventricular patch (endoaneurysmorrhaphy) after aneurysmectomy. Eight patients had isolated endoaneurysmorrhaphy, 60 patients had concomitant coronary artery bypass grafting, and 1 patient had concomitant closure of an atrial septal defect. The primary indications for operation were angina pectoris (New York Heart Association functional class I or II) in 42 patients and dyspnea (functional class III or IV) in 27 patients. The preoperative left ventricular ejection fraction evaluated with ventriculography was 28.95% +/- 7.27% (mean +/- standard error of the mean). The global perioperative mortality rate was 2.8%. Total follow-up was 139.3 patient-years. The late mortality rate was 4.3% per patient-year. A marked increase was found in the mean postoperative left ventricular ejection fraction of the patients: 41.91% +/- 11.83%. Survivors were interviewed in person: their functional status was class I or II in 58 patients and class III in 3 patients. We conclude that left ventricular endoaneurysmorrhaphy results in satisfactory functional improvement and can be performed with relatively low early and late mortality rates.

Full-text

Available from: Yuksel Atay, Jun 20, 2014
Clinlical
Investigation
Ahmet
Hamulu,
MD
Berent
Discigil,
MD
Mustafa
Ozbaran,
MD
Yuksel
Atay,
MD
Tahir
Yagdi,
MD
Suat
Buket,
MD
Munevver
Yuksel,
MD
Isa
Durmaz,
MD
Endoaneurysmorrhaphy
for
Left
Ventricular
Aneurysm
Follow-up
in
69
Patients
We
reviewed
the
cases
of
69
consecutive
patients
who
underwent
physiologic
recon-
struction
of
the
left
ventricular
cavity
with
an
endoventricular
patch
(endoaneurysmor-
rhaphy)
after
aneurysmectomy.
Eight
patients
had
isolated
endoaneurysmorrhaphy,
60
patients
had
concomitant
coronary
artery
bypass
grafting,
and
1
patient
had
concomi-
tant
closure
of
an
atrial
septal
defect.
The
primary
indications
for
operation
were
angina
pectoris
(New
York
Heart
Association
functional
class
I
or
II)
in
42
patients
and
dyspnea
(functional
class
Ill
or
IV)
in
27
patients.
The
preoperative
left
ventricular
ejection
frac-
tion
evaluated
with
ventriculography
was
28.95%
±
7.27%
(mean
±
standard
error
of
the
mean).
The
global
perioperative
mortality
rate
was
2.8%.
Total
follow-up
was
139.3
patient-years.
The
late
mortality
rate
was
4.3%
per
patient-year
A
marked
increase
was
found
in
the
mean
postoperative
left
ventricular
ejection
fraction
of
the
patients:
41.91
%
+
11.83%.
Survivors
were
interviewed
in
person;
their
functional
status
was
class
I
or
II
in
58
patients
and
class
Ill
in
3
patients.
We
conclude
that
left
ventricular
endoaneurys-
morrhaphy
results
in
satisfactory
functional
improvement
and
can
be
performed
with
relatively
low
early
and
late
mortality
rates.
(Tex
Heart
Inst
J
1996;23:207-10)
Ve
entricuLlar
aneurys-sm
is
a
meclhanical
complication
of
transmIlLural
m-ocar-
dial
infarction
(MI)
that
develops
in
3.5%)/
to
20%
of
infarction
patients
and
freqUently
requires
surgical
intervention.'
Since
1958.
when
Coolev2
performed
the
1st
postinfarction
left
v-entricular
(LNV)
aneurvsmectom-v
with
car-
diOpUlmionarv
bypass.
that
proceduLre
has
had
an
important
role
in
the
man-
ageiment
of
patients
with
ischemic
lheart
disease.3
Howvever.
most
investigators
perforimed
the
standard
linear
repair
of
the
aneurysm,
and
their
reports
on
the
efficacy
of
LV
aneurvsmnectomv
lhav-e
been
in
conflict.31'
WXhen
the
importance
of
the
left
v-entricle's
geometry
to
its
proper
function
was
understood.
newv
recon-
struLcti-e
techniquLes
were
introduced
for
patients
w-ith
LV
aneurysms.'
\Ve
reviewed
ouLr
surgical
treatIment
of
LV
aneurysms
to
assess.
retrospectively.
the
efficacy
of
restoring
intrav-entricuLlar
geometry
after
aneuryssmectomny
in
this
consecutix-e
series
of
patients.
Patients
and
Methods
Key
words:
Endoaneurys-
morrhaphy;
heart
aneurysml
surgery
From:
The
Department
of
Cardiovascular
Surgery,
Ege
University
Medical
Faculty,
lzmir
35100,
Turkey
Address
for
reprints:
Ahmet
Hamulu,
MD,
Assistant
Professor,
Department
of
Cardiovascular
Surgery,
Ege
University
Medical
Faculty,
lzmir35100,
Turkey
Froimi
1
Februarv
1991
throtuglh
31
MIay
1995.
69
consecutive
patients
wvith
left
-entrictular
aneurysm
underwent
reconstructiv-e
surgery
at
ouLr
institution.
There
were
-
women
ancd
62
men.
wvhose
ages
ranged
from
29
to
69
years
-(mean.
5-.3
years).
The
primary
indication
for
operation
was
angina
pectoris
in
42
patients.
ancl
dvspnea
in
2-
patients.
The
other
2
indications
for
operation
commonly
as-
sociatecd
with
left
ventricular
aneurysm-life-threatening
ventricular
arrhythmia
and
peripheral
emholi-were
not
seen
in
this
group
of
patients.
All
patients
hacd
coronary
arteriographv
ancl
left
ventriculographv
preopera-
tivelv.
Motion
of
the
anterior.
inferioi-,
and
lateral
v-entricular
-walls,
as
show
n
hb
ventriculography.
wvas
ev-aluated
hy
assessing
the
walls
velocity
ancl
displacement.
Wall
motion
was
graded
as
normilal.
hvpokinetic.
dvskinetic.
or
akinetic.
Left
v-entricular
aneurysm-n
was
definecl
as
a
thinned
and
dilated
portion
of
the
left
v-entricle
with
distinct
margins,
deimionstrating
akinesia
or
dyskinesia
dturing
-en-
tricular
contraction.
On
the
basis
of
coronary
angiographv.
patients
were
classified
as
having
single-
or
muLltiple-x-essel
clisease.
depencling
on
whether
oI
not
they
hlad
significant
(>
50%',,)
obstructions
in
the
left
anterior
descending,.
right.
or
circumilflex
coronary-
Endoaneurysmorrhaphy
for
Left
Ventricular
Aneurysm
20-
Texas
Heart
Iiistitlite
[ournal
Page 1
arterial
systems.
Preoperative
coronary
angiograplhy
revealed
single-vessel
disease
in
21
patients
(30.4%0)
and
multiple-vessel
disease
in
48
patients
(69.60o).
Anterior
and
anteroseptal
MI
wx
as
diagnosecl
in
all
69
patients,
and
inferior
MI
in
25
patients.
The
mean
preoperative
left
ventriCUlar
ejection
fraction,
as
determined
with
the
aid
of
ventrictulography.
wxas
28.95%
±
7.27%
(mean
±
SEM).
The
preoperative
distribution
of
patients
in
accor-
dance
wvith
Newv
York
Heart
Association
(NYHA)
classification
was
as
follows:
1
patient
was
in
class
IV
(1.400),
26
patients
were
in
class
III
(37.7%),
42
patients
wvere
in
class
II
(60.90()).
and
there
xvas
no
patient
in
class
I
(Fig.
1).
Eight
patients
had
isolated
aneurysm
repair.
60
patients
hacl
ventricular
aneurysmi
repair
wx-itlh
coro-
nary
artery
hypass
grafting,
and
1
patient
hlad
con-
comitant
closure
of
an
atrial
septal
defect.
Operative
Procedure
The
operation
w
as
perforimiecl
through
a
miiedian
sternotomy.
Cardiopulmonary
bypass
with
systemlic
hypothermia
(28
to
30
°C)
andl
multidose
hypotlher-
mic
blood
cardioplegia
with
warm
incluction
wvere
used
in
all
patients.
Pericarclial
adhesions
were
dis-
sected
while
the
empty
heart
wvas
still
heating.
An
aortic
root
cannula
was
uLsed
for
delivering
the
blood
cardioplegic
sollution
ancd
venting
the
leart.
Upon
asystole,
repair
of
the
left
v-entricular
aneurysm
w\
aas
begun.
The
thin
portion
of
the
scar
had
been
identi-
fied
as
it
collapsed
on
itself
w,hen
the
heart
was
on
full
vented
hypass,
and
a
ventriculotomy
was
per-
formed
parallel
to
the
left
anterior
descencling
coro-
nary
artery.
To
facilitate
inspection
of
the
cavity
and
work
through
the
incision,
heavy
traction
sutures
were
placed
along
the
margins
of
the
ventriculot-
omy.
Intraventricular
clot,
when
present,
was
re-
movecl
and
the
xentricle
was
irrigated
wxith
cold
45
-
40
-
E
Preop
c
35
=
Postop
a)
30
25
25
~.20
-Q
1
5
E
I
1
0
z
5
F
0
11
IIIlI
NYHA
Class
Fig.
1
Bar
graph
of
preoperati've
(Preop)
and
postoperative
(Postop)
distributi'On
of
pati'ents
by
New
York
Heart
Associ'a-
ti'on
(NYHA)
classi'ficati'on.
saline.
One
pursestring
suture
was
then
placed
at
the
margins
of
the
normal
myocardium
(Fig.
2A)
ancd
puLlled
to
exclude
the
fibrouLs
tissue
and
to
restore
(very
nearly)
the
original
size
and
slhape
of
the
left
ventricuLlar
cavity
(Fig.
2B).
Then,
a
circtular
Dacron
patch
prepared
from
wvoven
double-velour
vascular
graft
(Hemashield,
Meadox
Medicals,
Inc.:
Oakland,
N,J)
wvas
tailorecl
to
the
size
of
this
reCdLuced
opening
in
the
ventricle
and
sutuLred
with
continuLous
2-0
polypropylene
directly
to
the
enclocardium
at
the
transition
zone
between
scarred
and
viable
myocar-
diuLm
(Fig.
2C).
In
this
fashion,
the
ventricular
cavity
was
so
reconstruLctecd
that
all
of
the
thinned-out
myocardlium
on
both
the
free
wall
and
the
septum
was
excluded.
The
infarcted
Nall
wxas
then
closed
with
ruLnning
2-0
polypropylene
sutLure
(Fig.
2D).
After
ventricuLlar
repair,
coronary
artery
bypass
graft-
ing
wvas
performecl.
A
single
periocl
of
cardiac
arrest
wvas
ulsed
for
aneurysmii
repair
and
for
performiiance
of
all
clistal
coronary
artery
anastomiioses.
Proxinial
anastomiioses
were
performed
witlh
the
aortic
cross-
clamiip
removed
and
the
heart
beating.
The
location
of
the
aneurysm,
as
Cdoculmented
at
sUrger
y,
was
anteroapical
in
all
patients.
Intraven-
tricular
thrombus
wvas
noted
in
34
patients.
The
meean
cardiopulmonary
hypass
timiie
wvas
140.78
+
54.25
min
(range.
50
to
337
min).
The
mean
aor-tic
cross-clamiip
time
was
92.47
±
32.59
min
(range,
18
to
189
min).
Intraaortic
balloon
couinterpuLlsation
waS
uLsed
for
postoperative
hemnodvnamic
suLpport
in
8
patients
(11.60%o).
Thirty-twvo
patients
(46.40
o)
hald
inotropic
support
during
weaning
from
cardiopulmiionary
hy-
pass.
Results
Early
Postoperative
Sequelae.
In
the
early
postop-
erative
period,
1
patient
Underwent
reoperation
for
bleeding,
2
patients
had
ventricular
fibrillation,
and
1
patient
had
perioperativ-e
MI.
Two
(2.90o)
of
the
69
patients
died
before
disclharge
froimi
the
hospital:
1
of
intractable
arrhythmia
and
the
other
of
LV
failure.
Preoperatively,
1
of
these
patients
hacl
dyspnea
and
wvas
in
NYHA
class
III;
the
other
had
angina
and
was
in
class
II
(Table
I).
Late
Mlor-talit,
and
Funiictionzal
nrlpr-ol
emnienzt.
Total
followX-up
was
139.3
patient-years.
The
late
mortal-
ity
rate
was
4.3%
per
patient-year
(6
patients).
One
patient
died
of
arrhythmia
during
the
3rdc
month:
3
patients
died
of
LV
failure
in
the
8th,
23rd,
and
34th
months;
and
2
patients
died
of
MI
in
the
12th
and
14th
months
after
discharge
from
the
hospital.
The
preoperative
NYHA
distribution
of
the
3
patients
w
ho
clied
of
LV
failure
was
class
III
in
2
and
class
IV
in
1,
and
the
main
indication
for
surgery
was
dys-
pnea
in
all
(Table
I).
All
3
patients
were
found
to
be
208
Endoaneurysmorrhaphy
for
Left
Ventricular
Aneurysm
blitine
2
-'.
N
iiiibei-
-.'.
1996
')
I
-)
Page 2
Fig.
2
Artist's
depiction
of
the
endoaneurysmorrhaphy
technique
described
in
the
text:
A)
a
pursestring
suture
is
placed
at
the
margins
of
the
normal
myocardium;
B)
the
pursestring
is
pulled
to
exclude
the
fibrous
tissue
and
to
restore
the
original
size
and
shape
of
the
left
ventricular
cavity;
C)
a
circular
Dacron
patch
is
sutured
directly
to
the
endocardium
at
the
transition
zone
between
scarred
and
viable
myocardium;
and
D)
the
infarcted
wall
is
closed
with
running
2-0
polypropylene
suture.
TABLE
1.
Early
and
Late
Mortality
Rates
of
69
Patients
Presenting
with
Angina
or
Dyspnea
as
Indications
for
Left
Ventricular
Endoaneurysmorrhaphy
No.
of
Early
Mortality
Late
Mortality
Overall
Survival
Indication
for
Operation
Patients
No.
%
No.
%
No.
%
Angina
(Class
or
11
CHF)
42
1
2.4
3
7.1
38
90.5
Dyspnea
(Class
IlIl
or
IV
CHF)
27
1
3.7
3
11.1
23
85.2
CHF
=
Congestive
heart
failure
Tcxwe.s
Heart)t
Institutte
Journal
Endoaneurysmorrhaphy
for
Left
Ventricular
Aneurysm
209
Page 3
in
class
III
at
the
time
of
postoperativTe
examuinations.
The
other
3
patients.
w-ho
diecl
of
arrhythmiia
or
MI,
were
in
class
II
preoperatively
and
stayed
in
class
II
postoperatively
(Table
I).
Follow-up
data
were
obtained
for
all
patients
who
survived
hospitalization.
Survivors
were
interviewed
in
person,
and
their
NYHA
classifications
wvere
de-
termined.
Early
postoperative
left
ventricular
func-
tion
was
evaluated
with
multigated
blood
pool
scans
in
51
patients
and
with
echocardiography
in
16
pa-
tients.
The
mean
postoperative
left
ventricular
ejec-
tion
fraction
was
found
to
he
41.91%
±
11.83%.
The
functional
status
of
the
late
Surxvivors
was
class
I
in
29
patients.
class
II
in
29
patients.
and
class
III
in
3
patients.
None
of
them
w,as
in
class
IV
(Fig.
1).
Discussion
colleaguLes.'2
and
by
Krajcer
and
coworkers.'3
have
also
clocumented
favorable
results
with
the
endo-
aneUryssmorrhaphy
technique.
In
the
present
series,
assessment
of
the
left
Xven-
tricular
function
of
the
survivors
in
a
follow-up
of
139.3
patient-years
revealed
a
marked
increase
in
ejection
fraction
of
the
left
ventricle.
This
improve-
ment
in
left
ventricular
function
w/as
in
keeping
writh
the
postoperative
_NYHA
class
distribution,
which
showed
95%
of
patients
in
classes
I
or
II
(Fig.
1).
Our
clinical
experience
demonstrates
that
recon-
struction
with
an
endocardial
patch
of
aneurysmal
damage
to
the
left
ventricle
(endoaneUrysmorrha-
p1y)
can
be
accomplished
with
a
low
mortality
rate
and
can
produce
sustained
symptomatic
relief.
References
The
preoperative
functioning
of
the
nonaneurysmiial
left
ventricle,
the
cardiac
geometry
after
ventricular
repair,
the
extent
of
coronary
artery
disease,
and
the
method
of
myocardial
protection
have
all
been
reported
to
influence
the
results
of
ventricular
an-
eurysm
repair.
--9
Our
management
of
ventricular
aneurysm
has
evolved
in
parallel
wTith
the
develop-
iment
of
newr
methods
that
substantiallv
improve
cardiac
function.
For
anteroapical
aneurysm.
wve
now
perform
endoaneurysmorrhaphy
essentially
as
Cooley
depicted
it
in
1989.839
The
patch
is
sewed
on-
to
contractile
areas
at
the
transition
zone
between
viable
and
scarred
tissue,
excluding
the area
of
sep-
tal
akinesia
without
causing
clistortion
of
the
right
ventricle.
The
remaining
muscle
is
reorganized
con-
centrically.
The
functional
improvement
after
repair
of
left
ventricular
aneurysm
with
this
technique
is
often
impressive.
Our
early
hospital
mortality
rate.
2.9%0
is
well
be-
low
the
reported
overall
lhospital
mortality
rates
of
surgical
series
in
which
the
conventional
linear
re-
pair
technique
was
used
for
treatment
of
left
ven-
tricular
aneuLrysm.
5
.6
l"
Previous
studies
have
reported
an
early
mortality
risk
of
between
500
and
21%,
the
highest
mortality
occurring
in
patients
with
congestive
heart
failure.'-"-'""
In
our
series,
angina
dominated
the
clinical
picture.
but
dyspnea
and
NYHA
class
III
or
IV
congestive
heart
failure
were
the
indications
for
surgery
in
4000
of
our
patients.
In
contrast,
the
relatively
low
hospital
mortality
rate
in
the
present
series
corresponds
wvith
those
of
other
series
in
wlhich
endoaneurysmorrlhaphy
wvas
the
method
of
choice
in
repair
of
left
ventrictular
aneurysm.
EqLuivalent
reductions
in
late
mortality
have
been
observed.
Six
of
the
67
survirvors
in
our
series
died
during
the
late
postoperative
period-,
3
of
these
had
syimiptoms
of
congestive
heart
failure
be-
fore
surgery
and
at
the
time
of
follow-up.
The
re-
ports
by
Di
Donato
and
associates.
by
Dor
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his
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Collins
HA.
Morris
GC
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Chapman
DwN.
Ven-
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a
fter
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SuIrg,iCtal
exCi-
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wVith
uLse
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JAMA
1958
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RK,
IMagovern
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Gott
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I)onahoo
IS.
GaLrdnerli
TI.
\'.atkins
L
Jr.
Left
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aneUrvsmectomv.
Factors
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j
Thor-aic
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MNI
Faintini
F.
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Sahatier
NI,
et
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Early
hemodrnnamic
resuLlts
of
left
ventriCLu-
lar
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sUrgery
for
anterior
wall
left
VentriClkr
aneurysm.
Am
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Miagovern
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Sakert
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K.,
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aneu-
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A
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Circulation
1989:-9(6
P't
2):
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6.
Cosgrove
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MN\V
Taylor
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Stewvart
RW,
Gocling,
LA,
M.a.hfood
S,
et
:tl.
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resection.
Trencds
in
SUr(lic.al
risk.
CirculaLtion
1989:79(6
Pt
2):I-9--101.
Jatene
AD.
Left
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or
reconstruLCtion.
I
Tlhoraic
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Surl(
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8.
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DA.
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encloaneurysmorrhaphy:
resuLlts
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ain
improved
methiocl
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Tex
Heart
In.st
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9.
CoolexL
DA.
VentricUlar
endloa.neuirv
simiorr-l
aphiv-:
a
siTtmplifiedl
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for
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J
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Stephenson
LW.
Hargrove
WXC
III.
Rateliffe
MIB.
FdcIlmuindls
Lli
Jr.
SUrt'ery
for
left
ventriculair
aneurysm.
Early
survival
with
and
WithoUt
endlocardial
resection.
Cil-C.ULtion
1989:-9(6
I't
2):I-108-l
1.
11.
Barratt-Boves
BG.
White
HD.
Agnew
T.I.
IPemherton
JR.
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CJ.
The
resUIlts
of
sUrgical
treatment
of
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ventricular
aneUrysms.
An
assessment
of
the
risk
faictoris
affecting
early
and
lalte
mortality.
ITh
'lior-ac
Cardlio:vsc
SUrg'
1984:87:87-98.
12.
I)or
V.
Saah
I.
)Coste
P'.
Kornaszewska
MN.
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.a
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MA.
CuLasav
L.
\entriCUIlar1
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of
a
new
operation
for
repairing
left
ventricu-
lar
aneUrysms
in
100
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Tex
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Instj
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Left
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2
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Number
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1996
Page 4
  • Source
    • "Nevertheless, hemodynamic improvements after standard aneurysmectomy remains controversial, and clinical results are debated. Some authors8910111213 report an increase in clinical and hemodynamic variables after aneurysmectomy, others [14– 18] record no improvements, nevertheless, none of these studies present a long-term follow-up. Dor et al. [19] have published a study that prospectively evaluates a large series of patients subjected to patch repair of an LV aneurysm in whom preoperative and postoperative hemodynamic studies have been performed. "
    [Show abstract] [Hide abstract] ABSTRACT: The temporal response to endoventriculoplasty (EVP) has not been well defined. We have evaluated the long-term clinical and functional results of this technique. From 1988 to 1997, 121 patients underwent aneurysmectomy by EVP associated with myocardial revascularization for anteroapical left ventricular postinfarction aneurysm. Among these, 39 patients (43%) underwent early post-operative cardiac catheterization (within 3 months maximum), and were available to be revaluated after a mean follow-up time of 56+/-28 months, by means of a new hemodynamic study. Left ventricular silhouettes were analyzed by means of a special software. The mean New York Heart Association functional class decreased from 2.5+/-0.9 to 1.6+/-0.8 (P<0.001) late postoperatively. The global ejection fraction improved early postoperatively from 43+/-13 to 61+/-13% (P<0.001), and late postoperatively slightly decreased to 42+/-13% (ns) versus preoperative values. Left ventricular end diastolic pressure early postoperatively fell from 16.8+/-7 to 15.7+/-6.7 (ns), and late postoperatively increased to 21.6+/-8.8 (ns) versus preoperative values. Pulmonary artery pressure rose early postoperatively from 31.5+/-6.4 to 32.1+/-6.7 (ns), and late postoperatively to 34.9+/-8.9 (ns). The global contractility score decreased early postoperatively from 42.3+/-9.6 to 28.4+/-13.6 (P<0.001); the global late postoperative contractily was 35+/-14 (ns) versus preoperative values. Patients who benefit most from the operation were those with a normal postoperative contraction pattern, where ejection fraction improved respectively early postoperatively from 43+/-13 to 63+/-11% (P<0.001), and late postoperatively to 49+/-10% (P<0.001) versus preoperative values. Occlusion or critical stenosis of bypass grafts occurred in 10 patients (25.6%). There were no significant differences in hemodynamic data and hypokinesis score changes between patients with patent or occluded bypass graft, and between patients with mono or multivessel disease. The operative mortality was 6.3%, and 8.8% needed intraaortic balloon counterpulsation. The actuarial survival rates at 5 and 7 years were 73+/-6 and 61+/-6%. The mean follow-up period was 68 months (with 112 months maximum). We conclude that, in our patients group, EVP of left ventricular aneurysm associated with coronary grafting improves clinical status after operation. We registered a trend for a mild hemodynamic worsening, irrespective of coronary artery disease except in those patients who had shown a normal postoperative contraction pattern.
    Full-text · Article · Apr 1999 · European Journal of Cardio-Thoracic Surgery
  • [Show abstract] [Hide abstract] ABSTRACT: The cardioreduction (Batista) procedure is a new surgical procedure being clinically performed for end-stage heart failure. It is the most recent of operations based on the concept of ventricular remodeling, among which dynamic cardiomyoplasty and temporary left ventricular assist device support are alternatives. Since the initial published report in 1996,cardioreduction has quickly been embraced by the public and many medical institutions throughout the world as an option to cardiac transplantation. There is very little scientific evidence regarding the beneficial effect and physiological principles behind cardioreduction. Since several clinical series are beginning to appear on the short-term results of cardioreduction, it is important to delineate the theoretical basis for the procedure. Cardioreduction is purported to be beneficial because it normalizes the cardiac ventricular mass-to-volume ratio. This review attempts to present the literature evidence of a universal ventricular mass-to-volume ratio and the physiological principle for cardioreduction.
    No preview · Article · Nov 1997 · Heart Failure Reviews
  • [Show abstract] [Hide abstract] ABSTRACT: Surgical reconstruction of physiological shape and size of a postischemically remodeled left ventricle has been advocated to improve ventricular function and improve patient long-term outcome. What initially started as linear aneurysm resection surgery developed over the years into the endoventricular repair techniques (surgical ventricular reconstruction, SVR) that have also been applied in patients with postischemically dilated ventricles and mainly anterior akinesia. SVR improved function as measured by the ejection fraction. Whether it affects survival was finally tested in the largest surgical trial ever conducted, the STICH trial (Surgical Treatment for IsChemic Heart failure). The trial, however, presented rather sobering information with its Hypothesis 2 outcome by demonstrating identical 5-year survival rates between SVR plus bypass grafting (CABG) and CABG alone. SVR also did not improve quality of life. This neutral finding spawned a series of critical responses with respect to trial design and conduct accompanied by appropriate responses by the trial's leadership. At the end of this dispute, it appears that SVR has been accepted as not very useful for most patients and is less and less performed in daily practice. What remains is a series of different perspectives that will be discussed in this review. The conclusion will be that SVR may be of low value for the patient with dilated and massively remodeled ventricles, but the technique bears therapeutic potential for some patients for different reasons so that the surgeon's ability to perform this operation should not get lost.
    No preview · Article · Jan 2012 · Heart Failure Reviews