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J Thorac Cardiovasc Surg 2004;128:449-456
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Surgery for left ventricular aneurysm: Early and late survival after simple linear repair and endoventricular patch plasty

^a Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, Oslo, Norway
^b Research Forum, Clinical Epidemiology Unit, Ullevaal University Hospital, Oslo, Norway

Received for publication October 28, 2003; revisions received April 7, 2004; accepted for publication April 23, 2004.

^* Address for reprints: Runar Lundblad, MD, Rikshospitalet, N-0027 Oslo, Norway
runar.lundblad{at}rikshospitalet.no

OBJECTIVE: Simple linear resection and endoventricular patch plasty are alternative techniques to repair postinfarction left ventricular aneurysm. The aim of the study was to compare these 2 methods with regard to early mortality and long-term survival.

METHODS: We retrospectively reviewed 159 patients undergoing operations between 1989 and 2003. The epidemiologic design was of an exposed (simple linear repair, n = 74) versus nonexposed (endoventricular patch plasty, n = 85) cohort with 2 endpoints: early mortality and long-term survival. The crude effect of aneurysm repair technique versus endpoint was estimated by odds ratio, rate ratio, or relative risk and their 95% confidence intervals. Stratification analysis by using the Mantel-Haenszel method was done to quantify confounders and pinpoint effect modifiers. Adjustment for multiconfounders was performed by using logistic regression and Cox regression analysis. Survival curves were analyzed with the Breslow test and the log-rank test.

RESULTS: Early mortality was 8.2% for all patients, 13.5% after linear repair and 3.5% after endoventricular patch plasty. When adjusted for multiconfounders, the risk of early mortality was significantly higher after simple linear repair than after endoventricular patch plasty (odds ratio, 4.4; 95% confidence interval, 1.1-17.8). Mean follow-up was 5.8 ± 3.8 years (range, 0-14.0 years). Overall 5-year cumulative survival was 78%, 70.1% after linear repair and 91.4% after endoventricular patch plasty. The risk of total mortality was significantly higher after linear repair than after endoventricular patch plasty when controlled for multiconfounders (relative risk, 4.5; 95% confidence interval, 2.0-9.7). Linear repair dominated early in the series and patch plasty dominated later, giving a possible learning-curve bias in favor of patch plasty that could not be adjusted for in the regression analysis.

CONCLUSIONS: Postinfarction left ventricular aneurysm can be repaired with satisfactory early and late results. Surgical risk was lower and long-term survival was higher after endoventricular patch plasty than simple linear repair. Differences in outcome should be interpreted with care because of the retrospective study design and the chronology of the 2 repair methods.

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