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J Thorac Cardiovasc Surg 2003;126:374-385
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Factors affecting late survival after surgical remodeling of left ventricular aneurysms

^a Divisions of Thoracic and Cardiovascular Surgery, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, Fla, USA
^b Cardiology, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, Fla, USA
^c Departments of Anesthesiology, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, Fla, USA
^d Epidemiology, and Public Health, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, Fla, USA

Read at the Twenty-eighth Annual Meeting of The Western Thoracic Surgical Association, Big Sky, Mont, June 19-22, 2002.

Received for publication July 15, 2002; revisions received September 3, 2002; revisions received October 11, 2002; accepted for publication October 28, 2002.

^* Address for reprints: Hooshang Bolooki, MD, FRCS (C), University of Miami/Jackson Memorial Hospital, PO Box 016960 (R-114), Miami, FL 33101, USA
hbolooki{at}med.miami.edu

OBJECTIVES: Surgical remodeling of the left ventricle has involved various techniques of volume reduction. This study evaluates factors that influence long-term survival results with 3 operative methods.

METHODS: From 1979 to 2000, 157 patients (134 men, mean age 61 years) underwent operations for class III or IV congestive heart failure, angina, ventricular tachyarrhythmia, and sudden death after anteroseptal myocardial infarction. The preoperative ejection fraction was 28% ± 0.9% (mean ± standard error), and the pulmonary artery occlusive pressure was 15 ± 0.07 mm Hg. Cardiogenic shock was present in 26 patients (16%), and an intra-aortic balloon pump was used in 48 patients (30%). The type of procedure depended on the extent of endocardial disease and was aimed at maintaining the ellipsoid shape of the left ventricle cavity. In group I patients (n = 65), radical aneurysm resection and linear closure were performed. In group II patients (n = 70), septal dyskinesis was reinforced with a patch (septoplasty). In group III patients (n = 22), ventriculotomy closure was performed with an intracavitary oval patch.

RESULTS: Hospital mortality was 16% (25/157) and was similar among the groups. Actuarial survival up to 18 years was better with a preoperative ejection fraction of 26% or greater (P = .004) and a pulmonary artery occlusive pressure of 17 mm Hg or less (P = .05). Survival was worse in patients who had intra-aortic balloon pump support (P = .03). Five-year survival for all patients in group III was higher than for patients in group II (67% vs 47%, P = .04).

CONCLUSIONS: Factors that improved long-term survival after left ventricular surgical remodeling were intraventricular patch repair, preoperative ejection fraction of 26% or greater, and pulmonary artery occlusive pressure of 17 mm Hg or less without the need for balloon pump assist.

Key Words: 22 • 30

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