Surgical treatment of the post-infarction left ventricular aneurysm. Factors influencing early and late results.
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 embolism 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 less than 0.01, and 37.9% versus 12.9%, p less than 0.01, respectively). Associated surgical procedures (p less than 0.001) and acuity of the LVA (p less than 0.05) also increased the operative risk. The 5 year-survival 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 global contractile score did reach significant levels (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
Gonzalez-Santos
J M
JM
Ennabli
K
K
Galinanes
M
M
Bosch
X
X
Lesperance
J
J
Pelletier
L C
LC
D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000401:mortality; D005260:Female; D006322:Heart Aneurysm / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011184:Postoperative Period; D011300:Preoperative Care; D011379:Prognosis; D013318:Stroke Volume; D013997:Time Factors