Long term follow up of left ventricular function after repair of left ventricular aneurysm. A comparison of linear closure versus patch plasty.

Abstract

Suboptimal early and unsatisfactory late results after linear closure of left ventricular aneurysms, have focused attention on more physiologic concepts of aneurysmectomy, like endoventricular patch plasty. The aim of our study was to compare clinical results of linear closure and patch plasty 8 years after surgery. From a total of 102 patients with postinfarctional left ventricular aneurysms, clinical outcomes and echocardiographic measurements of left ventricular function in 32 patients who underwent linear closure were compared to those of 20 patients who had endoventricular patch plasty. The two groups were matched with respect to age, gender, comorbid risk factors, functional class, urgency of the operation and concomitant procedures. In the patch plasty group, ejection fraction increased from 33.1+/-12.2% to 34.4+/-9.7%. In the linear closure group, ejection fraction decreased from 44.3+/-10.9% to 40.1+/-7.9%. Perioperative mortality and complications, long term survival and functional class were similar in both groups with a total perioperative mortality of 1.9%, an 8-year survival rate of 85.6%, and a mean NYHA functional class of 2.51. Long-term follow up showed a decline in ejection fraction in the direct closure group and a slight increase in the patch plasty group. We suggest that linear closure should be limited to small ventricular aneurysms and that large ventricular aneurysms extending into the septum should be treated by patch plasty.