Left ventricular aneurysm complicated by congestive heart failure: an analysis of long-term results and risk factors of surgical treatment.
The results of surgical treatment of post-infarction left ventricular aneurysms in 49 patients with congestive heart failure preoperatively were analyzed. Average patient age was 55 years. Preoperative total ejection fraction averaged 30.5 +/- 1.5% (mean +/- SEM), contractile segment ejection fraction was 42.5 +/- 1.1% and end-diastolic volume of aneurysm was 81.4 +/- 10.4 ml. Seventy eight percent of patients underwent coronary artery bypass grafting concomitantly with aneurysmectomy. Mean follow-up after operation was 41.5 +/- 3.5 months. Hospital mortality was 8.2%, the 5 year survival rate was 70 +/- 7% and the 5 year complication free rate was 52 +/- 8%. Mean functional class of dyspnea improved significantly from 2.9 +/- 0.1 preoperatively to 1.6 +/- 0.1 at late follow-up (p less than 0.001). Likewise, isotopic ejection fraction at rest increased from 13.7 +/- 1.3% preoperatively to 30.9 +/- 3.0% postoperatively (p less than 0.0001). Logistic regression analysis isolated two factors which influenced postoperative survival independently: contractile segment ejection fraction (p = 0.045) and myocardial score of left anterior descending coronary artery (p = 0.035). Combining these two risk factors, it was possible to identify a low risk group of patients with a 5 year survival probability of 93 +/- 6%, contrasting with a high risk group of patients having a 5 year survival of 57 +/- 9% (p less than 0.02). Thus, resection of left ventricular aneurysms complicated by congestive heart failure provides improvement in left ventricular function and clinical status.(ABSTRACT TRUNCATED AT 250 WORDS)
Louagie
Y
Y
Department of Surgery, Montreal Heart Institute, Université de Montréal, Quebec, Canada.
Alouini
T
T
Lesperance
J
J
Pelletier
L C
LC
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000150:complications* / Q000401:mortality / Q000601:surgery; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors