High incidence of sudden death late after anterior LV-aneurysm repair.
OBJECTIVE
Sudden death due to ventricular arrhythmias occurs frequently among patients with dilated cardiomyopathy and congestive heart failure (CHF). In patients with left ventricular (LV) aneurysms, LV-aneurysm repair (LVAR) reduces LV-size and ameliorates symptoms of CHF, but the incidence of late sudden death is unknown, especially after LVAR without concomitant anti-arrhythmic therapy.


METHODS
Between June 1993 and June 1999, 147 patients (70% males; 62+/-9 years) with CHF (median: NYHA III) due to anterior LV-aneurysms underwent LVAR. None of the patients underwent anti-arrhythmic surgical procedures concomitant to LVAR. Ninety percent of the patients had additional myocardial revascularization. Hospital records and laevocardiograms were reviewed, and follow-up information was obtained.


RESULTS
In-hospital mortality was 4.1% (n=6). The median follow-up was 3.7 years (0.1-73.4 months; overall 462 patient-years). At follow-up, the patients had significantly less symptoms than preoperatively (median: NYHA II, P<0.001). Nineteen patients had died (5-year survival rate 78%). Of these late deaths, 84% (n=16) were cardiac-related, among which sudden death was most frequent (n=7). Predictors of sudden death were a bypass graft to the right coronary artery (P=0.0100), ventricular tachyarrhythmias early postoperatively (P=0.0315), and cross-clamp time (P=0.0496).


CONCLUSIONS
Although the survival and functional state of most patients were good after LVAR without concomitant anti-arrhythmic surgery, we observed a high incidence of late sudden death, which was-among others-significantly associated with postoperative ventricular tachyarrhythmias. To further improve outcomes, intra- and postoperative anti-arrhythmic therapy is advisable in patients undergoing LVAR.
Matthias Bechtel
J F
JF
Department for Cardiac Surgery, University Hospital Schleswig-Holstein, Luebeck, Germany.
Tölg
Ralph
R
Graf
Bernhardt
B
Richardt
Gert
G
Noetzold
Axel
A
Kraatz
Ernst G
EG
Sievers
Hans-Hinrich
HH
Bartels
Claus
C
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D006322:Heart Aneurysm / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000150:complications; D016896:Treatment Outcome