The Journal of Thoracic and Cardiovascular Surgery, Vol 73, 772-779, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Long-term clinical and hemodynamic studies after ventricular aneurysmectomy and aorta-coronary bypass
JM Aranda, B Befeler, R Thurer, A Vargas, N El-Sherif and R Lazzara
Late clinical and hemodynamic evaluations in 18 patients with ventricular
aneurysmectomy and aorta-coronary bypass are presented. Tne patients had
significant obstructive lesions in two major vessels (55 per cent), and 6
had extensive three vessel disease (33 per cent). In 13 patients, 21
aorta-coronary saphenous bypass grafts were performed in addition to
aneurysmectomy. The operative mortality rate was 11 per cent. One patient
died suddenly 5 months after the operation (one year mortality rate 17 per
cent). The 15 surviving patients have been followed up for 12 to 41 months
(average 24 months). Clinical results were considered excellent in 2
patients who have been asymptomatic (Class I, N.Y.H.A.). Nine others were
considered to have good clinical results (Class II). Five patients have
continued to have congestive heart failure and angina on minimal effort
(Class III or IV). Six of the 11 patients considered to have excellent or
good results underwent postoperative hemodynamic studies 6 to 34 months
after the operation. A significant increase in cardiac index was documented
in all 6 patients. Paradoxic movement was not detected in any of the
postoperative ventriculograms. Five of the seven venous grafts inserted
were patent. Elevated left ventricular end-diastolic pressure (LVEDP), low
cardiac index, and a persistent dyskinetic area in the left ventricle were
found in 2 patients considered to have poor clinical results. Clinical and
hemodynamic evaluations have shown a significant improvement in most
patients surviving ventricular aneurysmectomy. However, postoperative
systemic embolism, myocardial infarction, progression of coronary artery
disease, transient cerebral ischemic attacks, graft occlusion, arrhythmias,
and mitral regurgitation in previously prolapsed mitral valve leaflets
account for progressive disability and limited activity after a successful
operation.
