title: Repair of postinfarction dyskinetic LV aneurysm with either linear or patch technique.
abstract: OBJECTIVE
  Controversy still exists regarding the optimal surgical technique for postinfarction dyskinetic left ventricular aneurysm (LVA) repair. We compared the efficacy of two established techniques, linear vs. patch remodeling, for repair of dyskinetic LVA.
  
  
  METHODS
  From 1989 to 1998, 95 (16 women, 79 men) consecutive patients were operated on for postinfarction dyskinetic LVA. Thirty-four patients underwent patch remodeling (R) and 61 linear (L) repair. The mean age was 61.1+/-8.5 years. Indications for surgery alone or in combination included angina in 72 patients, dyspnea in 64 and ventricular tachycardia in 41. Thirty-seven patients had a history of congestive heart failure (R 13 (38%), L 24 (39%), NS). The mean ejection fraction (EF) with aneurysm was 0.29+/-0.09 in R vs. 0.35+/-0.10 in L (P<0.04), whereas the mean EF without aneurysm was 0.43+/-0.11 in R vs. 0.46+/-0.08 in L (P=0.3). Seventy-one aneurysms were anterior (R 30 (88%), L 41 (68%), P<0.05). Concomitant coronary artery bypass grafting was performed in 84 patients (R 29 (85%), L 55 (90%), NS). Follow-up ranged from 1 to 12 years (mean 5.6+/-3.4 years, median 6.1 years).
  
  
  RESULTS
  Early mortality was 8% (n=8) (R 4, L 4, NS). Survival at 1, 5 and 10 years was 88, 73, and 44%, respectively. It did not differ significantly between R (1 and 5 year survival 85, 66%) and L (90, 76%, P=0.58). Preoperative risk factors for mortality were history of congestive heart failure (1 and 5 year survival 81 and 57% vs. 90 and 78%, respectively, hazard ratio (HR)=1.95, P<0.05), non-anterior localization of the aneurysm (86 and 49% vs. 86 and 77%, HR=2.06, P<0.05), history of thromboembolic events (57 and 19% vs. 89 and 74%, HR=3.27, P<0.05), and left ventricular EF (HR=0.97 per %, P=0.05). At late follow-up the mean functional class was 1.8+/-0.6 in long-term survivors (preoperative 2.9+/-0.9, P<0.001) with no difference between the groups.
  
  
  CONCLUSIONS
  The technique of repair of postinfarction dyskinetic LVA should be adapted in each patient to the cavity size and extent of the scarring process into the septum and subvalvular mitral apparatus. Applying these considerations to the choice of the technique of repair, both techniques achieved satisfactory results with respect to perioperative mortality, late functional status and survival.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Raemistrasse 100, 8091 Zurich, Switzerland. reza.tavakoli@triemli.stzh.ch
authors.forename: Reza
authors.initials: R
authors.lastname: Tavakoli
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
authors.forename: Alberto
authors.initials: A
authors.lastname: Weber
authors.forename: Hanspeter
authors.initials: H
authors.lastname: Brunner
authors.forename: Michele
authors.initials: M
authors.lastname: Genoni
authors.forename: Rene
authors.initials: R
authors.lastname: Pretre
authors.forename: Rolf
authors.initials: R
authors.lastname: Jenni
authors.forename: Marko
authors.initials: M
authors.lastname: Turina
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003323:Coronary Aneurysm / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D012189:Retrospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome