Surgical therapy for drug-refractory ventricular tachycardia: role of additional aneurysmectomy or bypass grafting.
To assess whether additional aneurysmectomy and/or bypass grafting influence prognosis we studied 97 patients with recurrent sustained monomorphic ventricular tachycardia after an old myocardial infarction. All patients underwent subendocardial resection due to drug-refractory ventricular tachycardia. There were 41 patients who had resection alone, 27 patients had resection and aneurysmectomy, 13 patients had resection and bypass grafting and the remaining 16 patients had resection with both, aneurysmectomy and bypass grafting. During the mean follow-up of 40 +/- 27 months 29 patients died (30%) (total mortality), 7 patients suddenly (7%) and 20 patients from cardiac causes (20%). There were no significant differences in total mortality between patients with resection alone (32%), patients with resection and aneurysmectomy (22%), patients with resection and bypass grafting (31%) and patients who had resection, aneurysmectomy and bypass grafting (38%). In addition, no significant differences were observed in the incidence of sudden death and nonfatal recurrences between patients with resection alone: sudden death 12%, recurrences 7%; patients with resection and aneurysmectomy: sudden death 0%, recurrences 19%; patients with resection and bypass grafting: sudden death 0%, recurrences 8%; and patients with resection, aneurysmectomy and bypass grafting: sudden death 13%, recurrences 0%. Postoperatively, left ventricular function improved in 56% of patients who had resection and aneurysmectomy compared to 17% of patients with resection alone, 31% of patients with resection and bypass grafting and 19% of patients who had resection, aneurysmectomy and bypass grafting. There is a low risk of sudden death and nonfatal recurrences after subendocardial resection. An influence of additional surgical approaches (aneurysmectomy or bypass grafting) on prognosis is not visible.
Trappe
H J
HJ
Department of Cardiology, University Hospital Hannover, Germany.
Klein
H
H
Frank
G
G
Wenzlaff
P
P
Lichtlen
P R
PR
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004699:Endocardium / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D013610:Tachycardia / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016277:Ventricular Function, Left