title: Surgery of left ventricular aneurysm: a meta-analysis of early outcomes following different reconstruction techniques.
abstract: BACKGROUND
  The purpose of this study is to assess the effects of linear and geometric left ventricular aneurysm reconstruction on early postoperative outcomes.
  
  
  METHODS
  A search of computerized databases supplemented with manual bibliographic review was performed for all peer-reviewed English language publications concerning randomized and nonrandomized studies reporting the results of left ventricular reconstruction after both linear and geometric reconstruction techniques. Meta-analyses of several short-term outcomes were performed.
  
  
  RESULTS
  No randomized trial was identified. Eighteen nonrandomized trials were found with a total of 1,814 and 803 patients who underwent linear and geometric reconstruction, respectively. Meta-analysis of all studies (n = 18) revealed an increased risk of in-hospital death for patients undergoing linear reconstruction (relative risk = 1.59, 95% confidence interval: 1.12 to 2.26, p = 0.01). The subanalysis of studies in which linear reconstruction was adopted mainly in the first period of time, and geometric reconstruction was adopted in a later phase, still showed a significant advantage in terms of in-hospital mortality for patients undergoing geometric reconstruction (n = 11 studies, relative risk = 1.89, 95% confidence interval: 1.22 to 2.93, p = 0.004). By contrast, when the two surgical approaches were carried out in the same time lag, there was no difference between linear and geometric reconstruction techniques (n = 7 studies, relative risk = 1.04, 95% confidence interval: 0.57 to 1.92, p = 0.89). No differences in the other outcomes of interest were observed.
  
  
  CONCLUSIONS
  The advantage for geometric reconstruction techniques in terms of in-hospital mortality shown in some studies can be an effect of learning curve or of improvement over time in management of these difficult patients. Further studies are required to clarify this issue.
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy. alessandro.parolari@cardiologicomonzino.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.forename: Moreno
authors.initials: M
authors.lastname: Naliato
authors.forename: Claudia
authors.initials: C
authors.lastname: Loardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Denti
authors.forename: Matteo
authors.initials: M
authors.lastname: Trezzi
authors.forename: Marco
authors.initials: M
authors.lastname: Zanobini
authors.forename: Massimo
authors.initials: M
authors.lastname: Porqueddu
authors.forename: Maurizio
authors.initials: M
authors.lastname: Roberto
authors.forename: Samer
authors.initials: S
authors.lastname: Kassem
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006322:Heart Aneurysm / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome