Surgical treatment of postinfarction anterior left ventricular aneurysms: linear vs. patch plasty repair.
BACKGROUND
The patch plasty repair is increasingly advocated over linear closure in the surgical treatment of postinfarction anterior left ventricular aneurysm (LVA). A comparative estimate of the clinical results of these two techniques seemed in order.


METHODS
Between 1985 and 2004, 53 patients (mean age of 64.2+/-8.3 years) underwent repair of anterior LVA. Twenty-seven patients underwent linear repair (group 1) and 26 patients patch plasty (group 2). The mean left ventricular ejection fraction was 33.9+/-8.2% in group 1 vs. 29.7+/-10.2% in group 2 (P=0.118). Preoperatively 85.2% of patients in group 1 were in NYHA functional class III or IV vs. 88.5% in group 2 (P=0.71). All patients had preoperative recurrent ventricular tachycardia (VT) and non-guided encircling cryoablation for treatment of VT was performed in all patients. Coronary revascularization was performed in 29.6% of patients in group 1 and 42.3% in group 2 (P=0.398).


RESULTS
The overall in-hospital mortality was 1.9% as one patient died of low cardiac output (LCO). LCO was the most frequent early postoperative complication and was observed in 66.7% of patients in group 1 vs. 65.4% in group 2 (P=1.000). LCO was related to right coronary artery disease on multivariate analysis (odds ratio 6.9, P=0.0097). Mean follow-up was 6.4+/-4.8 years (range 1 day-17.5 years). Overall survival at 10 years was 65.5% of patients in group 1 vs. 60.6% in group 2 (P=0.395). At 10 years, 91.5% of patients were free from VT or sudden death in group 1 vs. 81% in group 2 (P=0.269). At follow-up the patients' functional status improved and among survivors 76.9% in group 1 were in NYHA functional class I-II vs. 62.5% in group 2 (P=0.432). Deaths from congestive heart failure (CHF) occurred in 38.5% of patients in group 1 vs. 55.6% in group 2 (P=0.632). On multivariate analysis a preoperative left ventricular end-diastolic pressure above 20 mmHg was a predictor of mortality from CHF (odds ratio 9.6, P=0.038).


CONCLUSIONS
Our study did not reveal significant differences between linear closure and patch plasty repair in the short- and long-term. The choice of repair technique should be adapted to each patient's anatomical and physiological characteristics.
Mukaddirov
Mirdavron
M
V. Vakhidov Research Centre of Surgery, Tashkent, Uzbekistan.
Frapier
Jean-Marc
JM
Demaria
Rolland Georges
RG
Albat
Bernard
B
D000368:Aged; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D003452:Cryosurgery; D005260:Female; D006322:Heart Aneurysm / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016017:Odds Ratio; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D013536:Suture Techniques; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left