PMID- 19833594
OWN - NLM
STAT- MEDLINE
DCOM- 20100127
LR  - 20091016
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 12
IP  - 5
DP  - 2009 Oct
TI  - Surgical treatment of left ventricular aneurysms: a comparison of long-term 
      follow-up of left ventricular function for classic aneurysmectomy and 
      endoaneurysmorrhaphy techniques.
PG  - E272-8
LID - 10.1532/HSF98.20091066 [doi]
AB  - OBJECTIVE: Myocardial infarction may be complicated by the formation of a left 
      ventricular (LV) aneurysm that distorts the normal elliptical geometry of the 
      ventricle to produce a dilated spherical ventricle with limited contractile and 
      filling capacities. One of the consequences is congestive heart failure, which 
      may be refractory to medical therapy and require surgical treatment. The aim of 
      this study was to evaluate LV function in the late term following repair of LV 
      aneurysm. METHODS: Ninety-seven patients underwent repair of postinfarctional LV 
      aneurysms. Sixty-one patients (62.9%) underwent classic aneurysmectomy, and 36 
      patients (37.1%) had endoaneurysmorrhaphy. The mean age (+/-SD) of the 87 men 
      (89.7%) and 10 women was 55.98 +/- 8.59 years. Coronary surgery was performed in 
      82 patients (84.5%), with a mean of 1.34 +/- 0.77 grafts/patient. The mean 
      preoperative ejection fraction (EF) was 39.74% +/- 8.79% (classic, 39.92% +/- 
      8.90%; endoaneurysmorrhaphy, 39.43% +/- 8.61%; difference not statistically 
      significant [NS]). Fifty-five patients (56.7%) had angina of Canadian 
      Cardiovascular Society class III to IV (classic, 55.7%; endoaneurysmorrhaphy, 
      58.3%; NS), 31 patients (31.9%) were in New York Heart Association (NYHA) class 
      III to IV (classic, 31.1%; endoaneurysmorrhaphy, 33.3%; NS), and the mean 
      preoperative NYHA functional class was 2.88 +/- 0.74 (classic, 2.83 +/- 0.77; 
      endoaneurysmorrhaphy, 2.97 +/- 0.71; NS). RESULTS: The mortality rate at <30 days 
      was 9.8% (n = 6) in the classic aneurysmectomy group and 2.7% (n = 1) in the 
      endoaneurysmorrhaphy group. Long-term follow-up was available for 80 of these 
      patients. During a mean follow-up of 79.3 +/- 37.6 months (range, 6-156 months), 
      14 patients (17.5%) died of a cardiac-related cause (classic, 8 patients [16.6%]; 
      endoaneurysmorrhaphy, 6 patients [18.7%]; NS). The cardiac-related survival rate 
      was 82.5%. In the first year, at 5 years, and at 10 years, the survival rates of 
      the patients who underwent classical aneurysmectomy were 98.8%, 93.5%, and 76.1%, 
      respectively, and the rates for patients who underwent endoaneurysmorrhaphy were 
      100%, 93.0%, 71.2%, respectively (P = .2). In the follow-up patient population, 
      the mean preoperative EF was 40.21% +/- 9.44% in the classic aneurysmectomy group 
      and 39.34% +/- 8.61% in the endoaneurysmorrhaphy group. Postoperatively, mean EFs 
      increased to 44.24% +/- 9.50% and 43.80% +/- 8.81%, respectively, at the last 
      follow-up. NYHA functional class changed from 2.79 +/- 0.77 preoperatively to 
      1.60 +/- 0.73 postoperatively in the classic aneurysmectomy group and from 2.97 
      +/- 0.71 preoperatively to 1.34 +/- 0.54 postoperatively in the 
      endoaneurysmorrhaphy group. There was no significant difference in hospital 
      readmissions for cardiac causes (classic, 27.1%; endoaneurysmorrhaphy, 31.2%). 
      CONCLUSION: LV aneurysm can be repaired with acceptable surgical risk. Surgical 
      treatment of LV aneurysm is associated with an improvement in long-term survival 
      and symptoms.
FAU - Erbasan, Ozan
AU  - Erbasan O
AD  - Department of Cardiac and Vascular Surgery, University Hospital of Akdeniz, 
      Antalya, Turkey. ozzan70@gmail.com
FAU - Turkay, Cengiz
AU  - Turkay C
FAU - Mete, Atalay
AU  - Mete A
FAU - Turkay, Mehtap
AU  - Turkay M
FAU - Golbasi, Ilhan
AU  - Golbasi I
FAU - Yilmaz, Huseyin
AU  - Yilmaz H
FAU - Erdem, Ozan
AU  - Erdem O
FAU - Bayezid, Omer
AU  - Bayezid O
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Aged
MH  - Cause of Death
MH  - Comorbidity
MH  - Coronary Artery Bypass
MH  - Disease-Free Survival
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Aneurysm/*surgery
MH  - Heart Failure/*mortality
MH  - Heart Ventricles/*surgery
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/mortality
MH  - Postoperative Complications/*mortality
MH  - Ventricular Dysfunction, Left/*mortality
EDAT- 2009/10/17 06:00
MHDA- 2010/01/28 06:00
CRDT- 2009/10/17 06:00
PHST- 2009/10/17 06:00 [entrez]
PHST- 2009/10/17 06:00 [pubmed]
PHST- 2010/01/28 06:00 [medline]
AID - B4241786318P11M7 [pii]
AID - 10.1532/HSF98.20091066 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2009 Oct;12(5):E272-8. doi: 10.1532/HSF98.20091066.