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The Journal of Thoracic and Cardiovascular Surgery, Vol 88, 544-553, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Left ventricular aneurysm. Ten years' experience in surgical treatment of 244 cases. Improved clinical status, hemodynamics, and long-term longevity

AS Olearchyk, GM Lemole and PM Spagna

This report reviews 244 patients with postinfarction left ventricular aneurysm operated upon between 1971 and 1980. The location of the left ventricular aneurysm was anteroapical (64.7%), apical (21.3%), posteroinferior (8.6%), or lateral (5.3%). The aneurysm was caused by a significant lesion of two coronary arteries in 38.9%, of three in 33.6%, and of a single left anterior descending artery in 26.6%. The indication for operation was angina (61.1%), congestive heart failure (9.8%), intractable ventricular arrhythmias (7.8%), or a combination of the above (20.9%). Of the 218 patients who survived the perioperative period (mean 56.5 months' follow-up), 85.3% were relieved of angina and 70.5% were in Class I or II of the New York Heart Association, as compared to 16% prior to operation. Cardiac index increased from 2.4 +/- 0.7 L/min/BSA before left ventricular aneurysmectomy to 3 +/- 0.5 L/min/BSA (p less than 0.001) at 1 to 12 weeks' follow-up. Left ventricular end-diastolic volume decreased from 111.4 +/- 55.4 ml/m2 before left ventricular aneurysmectomy to 73 +/- 21.7 ml/m2 (p less than 0.001) 1 year or more later. Mean velocity of circumflex fiber shortening of the contractile portion had increased from 0.7 +/- 0.3 circ/sec before left ventricular aneurysmectomy to 0.94 +/- 0.29 circ/sec (p less than 0.05) at 1 year or more. Left ventricular aneurysmectomy alone was performed in 10.7% patients, with an operative mortality of 7.7% and an actuarial 10 year survival rate of 56.8% +/- 10.6%. Left ventricular aneurysmectomy with coronary artery bypass was done in 89.3% of the patients, with an operative mortality of 11% and an actuarial 10 year survival rate of 69% +/- 3.6%. Operative mortality after grafting of the left anterior descending artery, its diagonal branch, and the circumflex artery was 9.5%, 11.3%, and 11.9%, respectively, and the actuarial 10 year survival rate was 72.8% +/- 3.8%, 70.7% +/- 7%, and 66.3% +/- 6%, respectively. Left ventricular aneurysmectomy combined with procedures on the mitral, aortic, or tricuspid valves or closure of a ventricular septal defect was done in 8.2%, with an operative mortality of 20% and an actuarial 10 year survival rate of 60% +/- 10.9%.

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