Left ventricular aneurysm resection with port-access surgery: a new mini-invasive surgical approach.
BACKGROUND
In recent years port-access and endovascular extra-corporeal circulation techniques have allowed valvular and coronary operations to be performed by mini-thoracotomy. Experience with the technique suggested application to resection of ventricular aneurysms, which are usually approached through a median sternotomy with the use of traditional cardiopulmonary bypass.


METHODS
We performed a left port-access mini-thoracotomy, with 6 to 8 cm skin incisions, in 7 patients undergoing endoventricular pericardial patch repair for anterior left ventricular aneurysm. Cardiopulmonary bypass was effected using the Heartport system. The mean interval between myocardial infarction and operation was 60.4 +/- 57.7 months. Three patients developed sustained ventricular tachicardia. Mean preoperative ejection fraction was 34% +/- 11%. Associated procedures were coronary bypass grafting in 2 patients and cryosurgery in 3 patients.


RESULTS
All patients survived to discharge and are alive and well after an average 14.5 months. They are all in NYHA class I-II. Postoperative echocardiograms revealed an average ejection fraction of 48.0% +/- 7.5% (p = 0.006 compared with preoperative value). The 3 patients who had cryosurgery did not demonstrate any recurrence of arrhythmias.


CONCLUSIONS
Left ventricular aneurysm can be successfully treated through port-access mini-thoracotomy with endovascular cardiopulmonary bypass, avoiding median sternotomy. This mini-invasive approach allows effective ventricular remodeling. Revascularization and antiarrhythmia surgery can also be done at the same time. In case of severely reduced ventricular function this approach permits fibrillatory arrest without aortic cross-clamping. The results are also good in terms of hospitalization time and long-term survival.
Alloni
Alessia
A
Department of Cardiac Surgery, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
Rinaldi
Mauro
M
Gazzoli
Fabrizio
F
D'Armini
Andrea M
AM
Viganò
Mario
M
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000295:instrumentation; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D010043:Outcome and Process Assessment, Health Care; D013523:Surgical Equipment; D013525:Surgical Instruments; D013908:Thoracotomy / Q000295:instrumentation*