Late follow-up after repair of left ventricular aneurysm and (usually) associated coronary bypass grafting.
This study assesses clinical and operative data (LV) aneurysm was repaired to determine factors that might predict in-hospital and long-term outcome. Long-term follow-up study was obtained in 296 of 298 patients undergoing LV aneurysm repair with or without coronary artery bypass grafting between 1974 and 1986. No patient had sustained a myocardial infarction within 2 weeks of surgery or was undergoing other concurrent cardiac surgery. The average age of the study patients was 57 +/- 9 years and the average ejection fraction was 35 +/- 13%. Ninety percent of the patients underwent concurrent bypass grafting, with an average of 2.2 +/- 1.3 grafts placed. Fourteen (5%) patients died in the hospital, with most deaths attributable to LV dysfunction. Advanced age and less extensive revascularization were correlates of in-hospital mortality. The 10-year survival was 57%, myocardial infarction-free survival 43%, and freedom from death, myocardial infarction and reoperative coronary surgery 41%. Advanced age, systemic hypertension, significant left main coronary artery narrowing and emergent operative status were multivariate correlates of long-term mortality. A low-risk population was defined by the absence of these risk factors, and high-risk by the presence of greater than or equal to 1 risk factors. The 10-year survival was 71% in the low-risk and 41% in the high-risk groups (p = .0006). The 10-year myocardial infarction free survival was 55% in the low-risk and 31% in the high-risk groups (p = 0.0017). LV aneurysm repair may be performed with acceptable in-hospital mortality, and the long-term risk may be stratified.(ABSTRACT TRUNCATED AT 250 WORDS)
Baciewicz
P A
PA
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Weintraub
W S
WS
Jones
E L
EL
Craver
J M
JM
Cohen
C L
CL
Tao
X
X
Guyton
R A
RA
D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications