Left ventricular aneurysm: Ten years’ experience in surgical treatment of 244 cases. Improved clinical status, hemodynamics, and long-term longevity

Abstract

This report reviews 244 patients with postinfarction left ventricular aneurysm operated upon between 1971 and 1980. The location of the left ventricular aneurysm was anteroapical (64.7%), apical (21.3%), posteroinferior (8.6%), or lateral (5.3%). The aneurysm was caused by a significant lesion of two coronary arteries in 38.9%, of three in 33.6%, and of a single left anterior descending artery in 26.6%. The indication for operation was angina (61.1%), congestive heart failure (9.8%), intractable ventricular arrhythmias (7.8%), or a combination of the above (20.9%). Of the 218 patients who survived the perioperative period (mean 56.5 months' follow-up), 85.3% were relieved of angina and 70.5% were in Class I or II of the New York Heart Association, as compared to 16% prior to operation. Cardiac index increased from 2.4 +/- 0.7 L/min/BSA before left ventricular aneurysmectomy to 3 +/- 0.5 L/min/BSA (p less than 0.001) at 1 to 12 weeks' follow-up. Left ventricular end-diastolic volume decreased from 111.4 +/- 55.4 ml/m2 before left ventricular aneurysmectomy to 73 +/- 21.7 ml/m2 (p less than 0.001) 1 year or more later. Mean velocity of circumflex fiber shortening of the contractile portion had increased from 0.7 +/- 0.3 circ/sec before left ventricular aneurysmectomy to 0.94 +/- 0.29 circ/sec (p less than 0.05) at 1 year or more. Left ventricular aneurysmectomy alone was performed in 10.7% patients, with an operative mortality of 7.7% and an actuarial 10 year survival rate of 56.8% +/- 10.6%. Left ventricular aneurysmectomy with coronary artery bypass was done in 89.3% of the patients, with an operative mortality of 11% and an actuarial 10 year survival rate of 69% +/- 3.6%. Operative mortality after grafting of the left anterior descending artery, its diagonal branch, and the circumflex artery was 9.5%, 11.3%, and 11.9%, respectively, and the actuarial 10 year survival rate was 72.8% +/- 3.8%, 70.7% +/- 7%, and 66.3% +/- 6%, respectively. Left ventricular aneurysmectomy combined with procedures on the mitral, aortic, or tricuspid valves or closure of a ventricular septal defect was done in 8.2%, with an operative mortality of 20% and an actuarial 10 year survival rate of 60% +/- 10.9%.