Therapy and results of surgery: requiring infarction complications. An 8-year experience.
Among myocardial infarction (MI) secondary complications requiring surgical intervention, the primary sequel is the left ventricular aneurysm (LVA), as a matter of fact, the ventricle septum rupture (VSR) and the moderate to severe ischemic mitral valve regurgitation (IMR) are common as secondary or third follow ones. Between June 1985 and June 1993 in our department, we performed 6418 operations with the support of the heart-lung-machine. This number includes 74 (1.15%) operations of MI complications; 38 interventions because of LVA, 18 operations because of IMR and 18 surgical corrections of VSR. In the great majority of cases a myocardial revascularization was performed simultaneously. Preoperatively the distribution of the whole patient population according to the functional NYHA classification was as follows: NYHA class I: 0, class II: 0, class III: 36 (48.6%), class IV: 27 patients (36.5%) and cardiogenic shock: 11 patients (14.9%). LVA surgery consists in aneurysmectomy and linear closure or endoventricular patch reconstruction, VSR was closed with synthetic patch material and the correction of IMR was performed mainly through partial resection and replacement with a prosthetic valve. Our early mortality was 13.1% for the LVA, 38.8% for the VSR and 11.1% for the IMR patient population, which was congruent with the rates quoted in current literature. The patient follow-up was done within a period of 6 to 90 months after discharge and the available results are very good. Late mortality was 15%. The actuarial survival rat after 7 years was 85% for the LVA, 82% for the VSR and 87% for the IMR patient population.(ABSTRACT TRUNCATED AT 250 WORDS)
Vicol
C
C
Herzchirurgische Klinik, Zentralklinikum Augsburg, Germany.
Hermann
H
H
Möckl
C
C
Struck
E
E
D000206:Actuarial Analysis; D000368:Aged; D000704:Analysis of Variance; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D004630:Emergencies; D005260:Female; D006322:Heart Aneurysm / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D009204:Myocardial Revascularization; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011379:Prognosis; D019736:Prostheses and Implants; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D018658:Ventricular Septal Rupture / Q000601:surgery*
D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene