PMID- 16039200
OWN - NLM
STAT- MEDLINE
DCOM- 20060905
LR  - 20061115
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 80
IP  - 2
DP  - 2005 Aug
TI  - Absent long-term benefit of patch versus linear reconstruction in left 
      ventricular aneurysm surgery.
PG  - 537-41; discussion 542
AB  - BACKGROUND: Endoventricular patch reconstruction of the left ventricle is 
      considered the gold standard in surgery for left ventricular aneurysms, because 
      of improved preservation of ventricular geometry. However, the superiority over 
      conventional linear closure has not been demonstrated, as assessed by the 
      long-term outcome. METHODS: Two hundred patients (66%) underwent linear closure 
      (group L) and 105 patients (34%) had endoventricular patch reconstruction (group 
      D) using the Dor technique. Linear closure has been performed since 1974 and from 
      1985 on the Dor technique has been applied as an alternative procedure. Both 
      patient groups differed regarding age, sex distribution, site of infarction, and 
      indication for surgery. Prior to the operation, 71% of the patients were in New 
      York Heart Association (NYHA) class III or IV and mean ejection fraction was 34% 
      +/- 12%. Follow-up extends up to 25 years, with a cumulative total of 2,605 
      patient years. RESULTS: Early mortality was 6.5% in group L vs 5.7% in group D 
      (not significant [NS]). Actuarial survival after 10 years was 56 +/- 3.2%, with 
      no difference between groups. Freedom from reoperation after 10 years was 95.6% 
      in group L vs 95.2% in group D (NS). Preoperative risk factors for late mortality 
      were age, left ventricular enddiastolic volume index and concomitant mitral valve 
      surgery. The type of procedure and the date of operation had no influence on 
      mortality. To date, 63% of the survivors are in NYHA class I and II. CONCLUSIONS: 
      In regard to long-term survival, rate of reoperation, and postoperative NYHA 
      functional class, no benefit could be demonstrated when linear closure was 
      compared with ventricular patch reconstruction for LV aneurysm repair. Hence, the 
      technique of ventricular reconstruction may not be as important as previously 
      thought, and at least for small aneurysms the simple and time sparing technique 
      of linear closure may still be considered.
FAU - Lange, Ruediger
AU  - Lange R
AD  - Department of Cardiovascular Surgery, German Heart Center, Clinic at the 
      Technical University, Munich, Germany. lange@dhm.mhn.de
FAU - Guenther, Thomas
AU  - Guenther T
FAU - Augustin, Norbert
AU  - Augustin N
FAU - Noebauer, Christian
AU  - Noebauer C
FAU - Wottke, Michael
AU  - Wottke M
FAU - Busch, Raymonde
AU  - Busch R
FAU - Mayr, Norbert
AU  - Mayr N
FAU - Meisner, Hans
AU  - Meisner H
FAU - Holper, Klaus
AU  - Holper K
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
RN  - 0 (Biocompatible Materials)
RN  - 0 (Polymers)
SB  - IM
MH  - Aged
MH  - Biocompatible Materials/therapeutic use
MH  - Cardiac Surgical Procedures/*methods/mortality
MH  - Female
MH  - Heart Aneurysm/*surgery
MH  - Heart Ventricles/surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Polymers/therapeutic use
MH  - Retrospective Studies
EDAT- 2005/07/26 09:00
MHDA- 2006/09/06 09:00
CRDT- 2005/07/26 09:00
PHST- 2004/01/27 00:00 [received]
PHST- 2005/02/22 00:00 [revised]
PHST- 2005/03/03 00:00 [accepted]
PHST- 2005/07/26 09:00 [pubmed]
PHST- 2006/09/06 09:00 [medline]
PHST- 2005/07/26 09:00 [entrez]
AID - S0003-4975(05)00374-7 [pii]
AID - 10.1016/j.athoracsur.2005.03.017 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2005 Aug;80(2):537-41; discussion 542. doi: 
      10.1016/j.athoracsur.2005.03.017.