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J Thorac Cardiovasc Surg 1994;107:690-698
© 1994 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Results of left ventricular aneurysmectomy with a tailored scar excision and primary closure technique

Toronto, Ontario, Canada

Supported by the Canadian Heart Foundation and The Heart and Stroke Foundation of Ontario.

Received for publication May 19, 1993. Accepted for publication Sept. 14, 1993. Address for reprints: Lynda L. Mickleborough, MD, Division of Cardiovascular Surgery, EN 13-217, 200 Elizabeth St., Toronto, Ontario M5G 2C4, Canada.

Abstract

Controversy exists concerning which surgical technique is optimal for ventricular aneurysm repair. In 92 (97%) of 95 patients, we tailored scar excision to remove nonfunctioning wall and restore left ventricular geometry and shape toward normal while allowing linear closure. Preoperative and/or postoperative multiple gated acquisition scans were obtained in 76 (83%) of 92 patients and Doppler echocardiograms in 79 (86%) of 92. Before operation 78 patients (85%) were in New York Heart Association class III or IV with congestive heart failure in 58 (63%), angina in 69 (75%) and syncope in 46 (50%) of the 92 patients. Additional operative procedures included aorta-coronary bypass grafting in 81 patients (88%), septoplasty in 4 (4%), and arrhythmia ablation in 54 (59%). Hospital mortality was 3 (3%) of 92 patients. There have been 15 late deaths caused by congestive heart failure with or without mitral regurgitation (7 of 15). Among survivors 66 (89%) of 74 were symptomatically improved with 25 (34%) of 74 in New York Heart Association class I, 24 (32%) of 74 in class II, 19 (26%) of 74 in class III, and 6 (8%) of 74 in class IV. Actuarial survival was 88%, 86%, and 80% at 1, 2, and 5 years, respectively, and was not different for patients with a preoperative left ventricular ejection fraction less than 20%. In 47 patients with an anterior aneurysm who had preoperative and postoperative studies, multiple gated acquisition scans showed improvement in left ventricular ejection fraction from 23% to 30% (p < 0.001). Preoperative Doppler echocardiograms showed significant mitral regurgitation (2+ or more) in 26 (36%) of 72 patients studied. Of these, 21 had postoperative studies and mitral regurgitation was improved by at least one grade in 12 (57%) of 21 patients. We conclude that aneurysm repair with a tailored scar excision and linear closure is associated with low operative mortality, objective evidence of improvement in left ventricular function, symptomatic relief, and long-term survival even in patients with advanced left ventricular dysfunction and mitral regurgitation. (JTHORAC CARDIOVASC SURG 1994;107:690-8)

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