Surgical ventricular reconstruction with endocardectomy along radiofrequency ablation-induced markings.
OBJECTIVE
The objective of this study was to evaluate the efficacy of a novel approach for endocardectomy during coronary artery bypass graft with surgical ventricular restoration in patients with postinfarction left ventricular aneurysm.


METHODS
One hundred sixty-eight patients underwent coronary artery bypass graft with surgical ventricular restoration from 2005 to 2011. Endocardectomy was performed as an integral part of surgical ventricular restoration for the prevention of ventricular tachycardia. The experimental group (surgical ventricular restoration-endocardectomy group; n = 74) underwent preoperative electrophysiologic study with electroanatomic left ventricular mapping. Radiofrequency ablation-induced markings were placed and were used later as guides for performing endocardectomy during coronary artery bypass graft with surgical ventricular restoration. The control group (surgical ventricular restoration group; n = 94) underwent surgical ventricular restoration without endocardectomy.


RESULTS
The 1-year mortality rates in the surgical ventricular restoration-endocardectomy and surgical ventricular restoration (control) groups were 5% and 13%, respectively. During the postoperative period, 3% of patients in the surgical ventricular restoration-endocardectomy group and 38% of patients in the surgical ventricular restoration group experienced ventricular tachycardia events (P < .05). Automatic implantable cardioverter-defibrillators were implanted in 11 patients in the surgical ventricular restoration group and in 1 patient of the surgical ventricular restoration-endocardectomy group for secondary prevention of sudden cardiac death.


CONCLUSIONS
When performed as an integral part of surgical ventricular restoration, endocardectomy was crucial in preventing postoperative ventricular tachycardia. Use of radiofrequency ablation-induced markings allowed clear visualization of the reentry zones for efficient endocardectomy during coronary artery bypass graft with surgical ventricular restoration, resulting in better patient outcomes.
Institute of Cardiology, Tomsk, Russia; S.P. Botkin City Clinical Hospital, Moscow, Russia. Electronic address: veb@cardio.tsu.ru.
Vadim
V
Babokin
Vladimir
V
Shipulin
Roman
R
Batalov
Sergey
S
Popov
D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D022062:Electrophysiologic Techniques, Cardiac; D004699:Endocardium / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006322:Heart Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome