title: Off-pump anteroapical aneurysm plication for left ventricular post-infarction aneurysm: long-term results.
abstract: BACKGROUND
  The temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair.
  
  
  METHODS
  From March 2005 to May 2010, 163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA), 54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B). All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed.
  
  
  RESULTS
  Early mortality was 1.8% for all patients (group A 1 death vs. group B 2 deaths, not significant (NS)). Peri-operative support included intraaortic balloon pumping in 16 (9.8%), (group A 6 patients vs. group B 10 patients, NS) and inotropic drugs in 84 (51.5%), (group A 34 vs. group B 50, NS). During a mean follow-up of (3.7±0.8) years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90 ± 0.59 to 1.65 ± 0.54 among the mid-term survivors (P < 0.001), with no significant difference between the two groups. Pre-operative risk factors for mortality or poor function were ejection fraction (EF) < 0.35 (OR = 7.9, 95%CI 1.6 - 40.0); congestive heart failure (CHF) (OR = 4.4, 95%CI 1.0 - 19.0); end-systolic volume index (ESVI) > 80 ml/m(2) (OR = 3.7, 95%CI 1.0 - 14.0); and advanced age > 70 years (OR = 2.4, 95%CI 1.0 - 12.0).
  
  
  CONCLUSIONS
  The technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality, providing good symptomatic relief and long-term survival, and similar results can be achieved with patch modeling repair.
authors.affiliation: Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xin-sheng
authors.initials: XS
authors.lastname: Huang
authors.forename: Cheng-xiong
authors.initials: CX
authors.lastname: Gu
authors.forename: Jun-feng
authors.initials: JF
authors.lastname: Yang
authors.forename: Hua
authors.initials: H
authors.lastname: Wei
authors.forename: Jing-xing
authors.initials: JX
authors.lastname: Li
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.forename: Ying
authors.initials: Y
authors.lastname: Fang
authors.forename: Rui
authors.initials: R
authors.lastname: Liu
authors.forename: Hai-tao
authors.initials: HT
authors.lastname: Li
authors.forename: Qi-wen
authors.initials: QW
authors.lastname: Zhou
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D006322:Heart Aneurysm / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors