Left ventricular aneurysmectomy: endoventricular circular patch plasty or septoexclusion.
BACKGROUND
Septoexclusion is a technique described by Guilmet in the mid 1980s. Its indications and midterm results are evaluated and compared to those obtained with the Dor operation.


METHODS
From January 1998 to April 2001, 79 patients had an exclusion of scars following myocardial infarction in left anterior descending artery (LAD) territory. Fifty of them (63.3%) had the Dor operation (Group D) and 29 (36.7%) the Guilmet operation (Group G). Dor technique was used when the involvement of the septum and the free wall was roughly similar. Guilmet technique was indicated when the septum was involved at a greater extent than the free wall. Ejection fraction (EF) was lower and end-diastolic volumes were higher in Group G. Incidence of functional mitral regurgitation was similar in both groups.


RESULTS
Thirty-day mortality was 7.6% (8.0% in Group D versus 6.9% in Group G, p = ns). After a mean of 21.0 +/- 8.5 months, five patients (6.9%) died, two in Group D and three in Group G. Causes of death were cardiac related in four and not cardiac related in one. Mean follow-up of the 68 survivors was 24.3 +/- 12.0 months (range: 4-38 months). Fifty patients (73.5% of the survivors) improved (28 in Group D and 22 in Group G, p = 0.026), whereas in 18, New York Heart Association (NYHA) class remained unchanged or worsened. Both groups showed an increase of EF and a volumetric reduction, whereas stroke volume remained unchanged. Fewer patients had mitral regurgitation than in the preoperative period (41.3% versus 65.8%, p = 0.013) and at a lesser extent (1.7 +/- 0.7 versus 0.7 +/- 0.6, p < 0.001).


CONCLUSIONS
Our results show that both Dor and Guilmet techniques are effective in the surgical treatment of left ventricular dyskinetic or akinetic areas related to LAD territory. Each technique has its own indications and has to be addressed to patients with different extension of septal scars.
Calafiore
Antonio Maria
AM
Department of Cardiology and Cardiac Surgery, University G. D'Annunzio, S. Camillo de' Lellis Hospital, Chieti, Italy. calafiore@unich.it
Gallina
Sabina
S
Di Mauro
Michele
M
Pano
Marco
M
Teodori
Giovanni
G
Di Giammarco
Gabriele
G
Contini
Marco
M
Iacò
Angela L
AL
Vitolla
Giuseppe
G
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D018421:Cardiomyoplasty / Q000379:methods / Q000401:mortality; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006322:Heart Aneurysm / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006334:Heart Function Tests; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011859:Radiography; D015635:Radionuclide Ventriculography / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery