title: Perioperative and long-term results with mapping-guided subendocardial resection and left ventricular endoaneurysmorrhaphy.
abstract: BACKGROUND
  Surgical ablation of the arrhythmogenic focus in patients with life-threatening ventricular tachyarrhythmias can be curative. However, the surgical techniques have been plagued by a high perioperative mortality rate (averaging approximately 12%). Reconstruction of the left ventricle may reduce mortality.
  
  
  RESULTS
  Reconstruction of the left ventricle with a pericardial patch, or endoaneurysmorrhaphy, was performed with mapping-guided subendocardial resection for recurrent ventricular tachycardia in 25 patients over a 5-year period. Postoperatively, electrophysiological studies were conducted to assess the results of surgery, which were further evaluated during long-term follow-up with survival analyses. The study included 25 patients, 60 +/- 9 years of age, with coronary artery disease, discrete left ventricle aneurysms, and malignant ventricular tacharrhythmias. Left ventricular ejection fraction was 24 +/- 6% preoperatively. Left ventricular endocardial mapping, endocardial resection, and endoaneurysmorrhaphy were performed in all patients. There was no operative or postoperative (30-day) mortality. Postoperative ventricular tachycardia was induced in 2 of the 25 patients (8%); left ventricular function increased to 32 +/- 9% (range, 19% to 52%). At a mean follow-up of 37 +/- 16 months (range, 6 to 65 months), there had been 6 deaths, including 1 sudden cardiac death, 2 congestive heart failure deaths, and 3 noncardiac deaths. Analysis of multiple variables failed to identify predictors of postoperative inducibility, sudden cardiac death, cardiac death, or total mortality.
  
  
  CONCLUSIONS
  Endoaneurysmorrhaphy with a pericardial patch combined with mapping-guided subendocardial resection frequently cures recurrent ventricular tachycardia with low operative mortality and improvement of ventricular function. Long-term follow-up demonstrates low sudden cardiac death rates.
authors.affiliation: Cardiac Arrhythmia Service, New England Medical Center Hospital, Boston, Mass. USA.
authors.forename: H
authors.initials: H
authors.lastname: Rastegar
authors.forename: M S
authors.initials: MS
authors.lastname: Link
authors.forename: C B
authors.initials: CB
authors.lastname: Foote
authors.forename: P J
authors.initials: PJ
authors.lastname: Wang
authors.forename: A S
authors.initials: AS
authors.lastname: Manolis
authors.forename: N A
authors.initials: NA
authors.lastname: Estes
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000601:surgery*