Long-term results after reconstructive surgery for aneurysms of the left ventricle.
BACKGROUND
Aneurysms of the left ventricle (LV) present a serious consequence of myocardial infarction, causing mechanical, thromboembolic, and arythmogenic complications. We present our experience in LV remodeling and long-term follow-up results.


METHODS
From May 1998 to February 2009, 85 patients with postinfarction LV aneurysm underwent reconstructive procedures. Mean age was 58.7 + or - 8.9 years (range 36-79 years). Average LV ejection fraction was 39.8% + or - 13.1% (range 20%-70%). Mean EuroScore was 6.0 + or - 2.9 (range 3-19) and predictive mortality was 8.2% + or - 11.9% (range 1.6%-85.6%). The majority of patients were in New York Heart Association functional class II (44%) preoperatively and 32% of patients were in New York Heart Association class III or IV. LV reconstruction was performed by using the endoventricular patch technique in 56 patients (66%). In 29 patients (34%) reconstruction was done by linear closure. In 79 patients (93%) concomitant myocardial revascularization was performed. Mitral valve procedures were performed in 11 patients (13%), (repair in 10 patients and replacement in 1).


RESULTS
Perioperative mortality was 3.5% (3 patients). Long-term follow-up was completed by means of phone interview with an average duration of 31.6 months (range 3-120 months). There were 9 late deaths (11%) during follow-up. Actuarial survival rates at 1, 5, and 10 years were 91%, 77%, and 68%, respectively. Fifty-nine patients (72%) were in New York Heart Association functional class I and II postoperatively.


CONCLUSIONS
LV remodeling is a safe surgical procedure with low perioperative morbidity and mortality and excellent long-term survival, even in patients with severely reduced systolic function.
Unić
Daniel
D
Division of Cardiac Surgery, Dubrava University Hospital, Av.Gojka Suska 6, 10 000 Zagreb, Croatia. dunic@kbd.hr
Barić
Davor
D
Sutlić
Zeljko
Z
Rudez
Igor
I
Ivković
Mira
M
Planinc
Mislav
M
Jonjić
Dubravka
D
D000328:Adult; D000368:Aged; D015897:Comorbidity; D017523:Croatia / Q000453:epidemiology; D005260:Female; D006322:Heart Aneurysm / Q000401:mortality* / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019651:Plastic Surgery Procedures / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000601:surgery*