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J Thorac Cardiovasc Surg 1994;107:1301-1308
© 1994 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
Florence, Italy and Monte Carlo, Monaco
Address for reprints: Vincent Dor, MD, Centre Cardiothoracique de Monaco, Av. D'Ostende 11 bis BP 223, 98004 Monaco Cedex.
Abstract
We analyzed the effects of nonguided endocardiectomy in patients with ischemic ventricular arrhythmias who underwent reconstructive operations for postinfarction left ventricular aneurysm. A total of 106 patients among 287 consecutive patients had spontaneous or inducible ventricular tachycardia (49 spontaneous and 57 inducible). Cryotherapy was done in 67 patients and coronary revascularization was done in 98%. Patients underwent complete hemodynamic study including programmed ventricular stimulation before and early after operation. Thirty-seven patients underwent hemodynamic evaluation after 1 year. The hospital mortality rate was 7.5%. At early and late studies the mean ejection fraction was significantly increased. Ventricular tachycardia was no longer inducible in 92% of patients after operation; only two patients had spontaneous ventricular tachycardia early after operation. At late study 10.8% of patients had inducible ventricular tachycardia and no spontaneous ventricular tachycardia was documented. All surviving patients had clinical follow-up (mean 21.3 months, range 2 to 64 months). There were eight late deaths and no episodes of ventricular tachycardia or syncope that necessitated hospitalization. In conclusion, nonguided, extended endocardiectomy associated with left ventricular reconstruction is safe and effective in curing ischemic spontaneous and inducible ventricular tachycardia. (J THORACCARDIOVASCSURG1994;107:1301-8)
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