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J Thorac Cardiovasc Surg 2003;126:323-325
© 2003 The American Association for Thoracic Surgery

Editorial

Ventricular aneurysms, shock, and late follow-up in patients with heart failure

^a Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Received for publication March 25, 2003; accepted for publication April 1, 2003.

^* Address for reprints: Patrick M. McCarthy, MD, Department of Thoracic and Cardiovascular Surgery, 9500 Euclid Ave, F25, Cleveland, OH 44195, USA
mccartp@ccf.org

Key Words: 22 • 26

The first 20% of the full text of this article appears below.

Bolooki and colleagues¹ describe their 22-year experience repairing left ventricular (LV) aneurysms using 3 surgical techniques that were introduced sequentially, with the technique used in group 3 being introduced most recently in 1992. During those 22 years, much has changed in the management of patients with heart failure and in cardiac surgery in general. Routine use of angiotensin-converting enzyme inhibitors and implantable cardioverter-defibrillators started after the initiation of their study.^2,3 The addition of ß-blockers, spironolactones, and biventricular synchronous pacing was introduced during the 1990s.^4-6 These interventions for heart failure have had a significant positive effect on the short-term and midterm prognoses for patients.⁷ Therefore, it is no surprise that the midterm survival for their most recent patients is better than that for the patients who underwent surgical intervention at an earlier time (groups 1 and 2).

Was the improvement in survival in group 3 patients as described by Bolooki and colleagues the result of the concept of surgical intervention being inherently better than in the techniques used in group 1 and 2 patients? Although they imply that their results are better, "especially with endoventricular patch technique,"¹ with so many other changes evolving during the same time, this is a classic apples and oranges comparison. Unfortunately, no amount of statistical matching would be able to account for the evolution of medical therapy during this period. Furthermore, the patients’ pathologies were different, which could make a crucial difference in late outcomes. The group 3 patients were chosen for this procedure because of minimal . . . [Full Text of this Article]