| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2001;121:675-682
© 2001 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
From the University of Toronto, Toronto, Ontario, Canada.
Received for publication March 23, 2000. Revisions requested June 20, 2000; revisions received Sept 7, 2000. Accepted for publication Oct 30, 2000. Address for reprints: Lynda L. Mickleborough, MD, EN 13-217 The Toronto Hospital, 200 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada.
Abstract
Objective: In patients with a dyskinetic or akinetic area of the left ventricle, controversy exists over who will benefit from resection. This study evaluates results achieved with a modified linear closure in 193 of 196 consecutive cases. Preoperative cases (n = 160 [83%]) were in functional class III or IV with congestive heart failure (n = 115 [60%]), angina (n = 108 [56%]), and syncope (n = 67 [35%]). The ejection fraction was 25% ± 8%, and echocardiography showed significant mitral regurgitation in 86 (45%) patients. In patients with detailed wall motion analysis, 50 (57%) were akinetic, and 37 (43%) were dyskinetic.
Methods: Repair was completed on the beating heart to minimize ischemia and allow assessment of wall function and viability to guide resection and repair. Additional procedures included coronary artery bypass grafting (n = 175 [91%]), septoplasty (n = 24 [12%]), and arrhythmia ablation (n = 77 [40%]). Ventricular and mitral valve function were assessed by means of preoperative and/or postoperative gated acquisition scans in 171 (90%) patients and Doppler echocardiograms in 170 (88%) patients.
Results: Hospital mortality was low (5/193 [2.6%]), although 34 (18%) patients needed perioperative intra-aortic balloon pump support. Actuarial survival at 1 and 5 years was 91% and 84%. Most late deaths were due to congestive heart failure. Seven patients required transplantation (interval, 36 ± 32 months). As determined by multivariable analysis, factors predicting poor outcome at 5 years were preoperative mitral regurgitation of 2+ or greater, congestive heart failure, and ventricular tachycardia. Among survivors, 126 (80%) of 157 were in functional class I or II, and the average increase in ejection fraction postoperatively was 9.1% ± 10.0%. Postoperative echocardiograms in 70 patients with significant mitral regurgitation preoperatively showed improved valve function in 40 (57%) of 70 patients.
Conclusions: We conclude that repair of dyskinetic or akinetic aneurysms by means of a modified linear closure plus septoplasty in selected patients can be accomplished in the beating heart with low operative mortality, provides good symptomatic relief and long-term survival, and is associated with objective evidence of improved left ventricular and mitral valve function.
Related Article
J. Thorac. Cardiovasc. Surg. 2001 121: 628-637.
This article has been cited by other articles:
|
|
 |
|
  P. Klein, J. J. Bax, L. J. Shaw, H. H.H. Feringa, M. I.M. Versteegh, R. A.E. Dion, and R. J.M. Klautz Early and late outcome of left ventricular reconstruction surgery in ischemic heart disease Eur. J. Cardiothorac. Surg., December 1, 2008; 34(6): 1149 - 1157. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Subramanian, B. Kunadian, and J. Dunning Is it worth performing surgical ventricular restoration in patients with ischemic cardiomyopathy and akinetic but non-aneurysmal segments in the left ventricle? Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 702 - 707. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. D. Glower and J. E. Lowe Left Ventricular Aneurysm Card. Surg. Adult, January 1, 2008; 3(2008): 803 - 822. [Full Text]
|
|
|
|
|
|
M. T. Spoor and S. F. Bolling Nontransplant Surgical Options for Heart Failure Card. Surg. Adult, January 1, 2008; 3(2008): 1639 - 1648. [Full Text]
|
|
|
|
 |
|
 L. M. Fedoruk, C. G. Tribble, J. A. Kern, B. B. Peeler, and I. L. Kron Predicting Operative Mortality After Surgery for Ischemic Cardiomyopathy Ann. Thorac. Surg., June 1, 2007; 83(6): 2029 - 2035. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Adams, L. M. Fedoruk, C. A. Tache-Leon, B. B. Peeler, J. A. Kern, C. G. Tribble, J. D. Bergin, and I. L. Kron Does Preoperative Ejection Fraction Predict Operative Mortality With Left Ventricular Restoration? Ann. Thorac. Surg., November 1, 2006; 82(5): 1715 - 1720. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Levine and E. Schwammenthal Ischemic Mitral Regurgitation on the Threshold of a Solution: From Paradoxes to Unifying Concepts Circulation, August 2, 2005; 112(5): 745 - 758. [Full Text] [PDF]
|
|
|
|
|
|
D. Mancini and D. Burkhoff Mechanical Device-Based Methods of Managing and Treating Heart Failure Circulation, July 19, 2005; 112(3): 438 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. E. Antunes, R. Silva, J. F. de Oliveira, and M. J. Antunes Left ventricular aneurysms: early and long-term results of two types of repair Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 210 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Lundblad, M. Abdelnoor, and J. L. Svennevig Surgery for left ventricular aneurysm: Early and late survival after simple linear repair and endoventricular patch plasty J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 449 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Buckberg Early and late results of left ventricular reconstruction in thin-walled chambers: Is this our patient population? J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 21 - 26. [Full Text] [PDF]
|
|
|
|
|
|
L. L. Mickleborough, N. Merchant, J. Ivanov, V. Rao, and S. Carson Left ventricular reconstruction: Early and late results J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 27 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.F. M. Bechtel, R. Tolg, B. Graf, G. Richardt, A. Noetzold, E. G. Kraatz, H.-H. Sievers, and C. Bartels High incidence of sudden death late after anterior LV-aneurysm repair Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 807 - 811. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Lundblad, M. Abdelnoor, and J. L. Svennevig Repair of left ventricular aneurysm: surgical risk and long-term survival Ann. Thorac. Surg., September 1, 2003; 76(3): 719 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bolooki, E. DeMarchena, S. M. Mallon, K. Katariya, M. Barron, H. M. Bolooki, R. J. Thurer, S. Novak, and R. C. Duncan Factors affecting late survival after surgical remodeling of left ventricular aneurysms J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 374 - 385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. L. Mickleborough, N. Merchant, Y. Provost, S. Carson, and J. Ivanov Ventricular reconstruction for ischemic cardiomyopathy Ann. Thorac. Surg., June 1, 2003; 75(90060): S6 - 12. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. D. Glower and J. E. Lowe Left Ventricular Aneurysm Card. Surg. Adult, January 1, 2003; 2(2003): 771 - 788. [Full Text]
|
|
|
|
|
|
L. L. Mickleborough Surgical Treatment of Ventricular Arrhythmias Card. Surg. Adult, January 1, 2003; 2(2003): 1287 - 1292. [Full Text]
|
|
|
|
|
|
V. Badhwar and S. F. Bolling Nontransplant Surgical Options for Heart Failure Card. Surg. Adult, January 1, 2003; 2(2003): 1515 - 1526. [Full Text]
|
|
|
|
|
|
F. Wellens, P. Geelen, E. Demirsoy, F. Van Praet, R. De Geest, I. Degrieck, H. Vanermen, and P. Brugada Surgical treatment of tachyarrhythmias due to postinfarction left ventricular aneurysm with endoaneurysmorrhaphy and cryoablation Eur. J. Cardiothorac. Surg., November 1, 2002; 22(5): 771 - 776. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Nomoto, T. Nishina, S. Miwa, H. Tsuneyoshi, I. Maruyama, K. Nishimura, and M. Komeda Angiotensin-Converting Enzyme Inhibitor Helps Prevent Late Remodeling After Left Ventricular Aneurysm Repair in Rats Circulation, September 24, 2002; 106(12_suppl_1): I-115 - I-119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Tavakoli, D. Bettex, A. Weber, H. Brunner, M. Genoni, R. Pretre, R. Jenni, and M. Turina Repair of postinfarction dyskinetic LV aneurysm with either linear or patch technique Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 129 - 134. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Konstantinov, L. L. Mickleborough, J. Graba, and N. Merchant Intraventricular mitral annuloplasty technique for use with repair of posterior left ventricular aneurysm J. Thorac. Cardiovasc. Surg., December 1, 2001; 122(6): 1244 - 1247. [Full Text] [PDF]
|
|
|
|
|
|
J. Raman, A. Dixit, M. Storer, D. Hare, and B. F. Buxton Geometric endo-ventricular patch repair of inferior left ventricular scars improves mitral regurgitation and clinical outcome Ann. Thorac. Surg., September 1, 2001; 72(3): S1055 - 1058. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. D. Buckberg Congestive heart failure: Treat the disease, not the symptom--Return to normalcy J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 628 - 637. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
