Aneurysmectomy and endocardial resection for ventricular tachycardia: Favorable hemodynamic and antiarrhythmic results in patients with global left ventricular dysfunction

Abstract

Sixty-two patients underwent aneurysmectomy and endocardial resection for control of recurrent sustained ventricular tachycardia (VT). Forty patients also had coronary artery bypass grafting (CABG) (1.5 grafts per patient). The mean preoperative left ventricular end-diastolic pressure (LVEDP) was 18 ± 8 mm Hg, cardiac index (Cl) was 2.7 ± 0.7 L/min/m 2, and ejection fraction (EF) was 28 ± 10%. In a subset of 32 patients with clearly demarcated aneurysmal and contracting ventricular sections, the mean EF of the residual contracting section (CSEF) was 35 ± 13%, and 26 of these patients had a CSEF < 45%. There were five operative deaths (8%). No hemodynamic findings distinguished the patients who died during surgery. Patients with an LVEDP above the group mean or an overall EF below the group mean had an operative mortality of 10% and 7%, respectively. In the subgroup of 26 patients with a CSEF < 45%, the operative mortality was 12%. In the surgical survivors as a whole the LVEDP decreased from 17 ± 8 to 14 ± 5 mm Hg ( p < 0.005) and the overall EF increased from 28 ± 9% to 39 ± 10% ( p < 0.001) while the normal CI did not change. Linear regression analysis revealed that patients with the highest preoperative LVEDPs and the lowest overall EFs were most likely to have improvement in these parameters postoperatively. Patients with a preoperative CSEF < 45% had similar postoperative changes in their LVEDP (17 ± 6 to 15 ± 4 mm Hg) and overall EF (24 ± 7% to 38 ± 11%). In addition, the incidence of inducible VT postoperatively was similar in patients with a preoperative CSEF < 45% (4 of 23) and in the rest of the group (8 of 34, p = NS). We conclude that: (1) patients with ventricular aneurysms and medically refractory VT often have marked dysfunction of the residual contracting LV section; (2) aneurysmectomy and endocardial resection is an effective mode of therapy for VT and can be performed with a low operative mortality in this patient population; and (3) postoperatively the angiographic EF usually increases and the LVEDP often decreases, especially in patients with the most marked preoperative LV dysfunction.