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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1998 Aprile;39(2):209-15

CARDIAC PAPERS 

 ORIGINAL ARTICLES

Early ­and ­late ­results ­after sur­gi­cal ther­a­py of ­postinfarc­tion ­left ven­tric­u­lar aneu­rysm

Pasi­ni S., Gag­li­ar­dot­to G., Pun­ta G., Del Ponte S., Ser­ra M., Pari­si F., Otti­no G., Di Sum­ma M.

From ­the Department of Cardiac Surgery, University of Turin, Italy

From 1979 to 1993, 139 ­patients ­had reduc­tion of ­left ven­tric­u­lar aneu­rysm (­LVA) by pli­ca­tion (PL) (25 cas­es) lin­e­ar ­repair (74 cas­es) or ven­tric­u­lar recon­struc­tion (VR) (40 cas­es). Coronary ­bypass graft­ing ­was per­formed in 89 ­patients. We ret­ro­spec­tive­ly ­reviewed ­our expe­ri­ence in ­order to iden­ti­fy pre­dic­tore of ear­ly ­and ­late out­come ­and deter­mine wheth­er ven­tric­u­lar recon­struc­tion (VR) ­can ­improve post­op­e­ra­tive ­and ­late prog­no­sis. Operative mor­tal­ity (OM) ­was 7.2%. Among 129 hos­pi­tal sur­vi­vors, 48 ­died dur­ing FU (LM). OM ­was relat­ed to a ­more ­recent myo­car­dial infarc­tion (p=0.0001), a high­er resid­u­al ­score (RS) (p=0.02), a low­er EF (p=0.038), a high­er ­left ven­tric­u­lar ­score (p=0.059), a ­three-­system dis­ease (­TSD) (p=0.09) ­and a ­right cor­o­nary dis­ease (RCD) (p=0.13). At Multivariate Analysis (Stepwise Logistic Regression) ­TSD (p=0.00l), ­RCD (p=0.008) ­and RS (p=0.04) ­are inde­pen­dent ­risk fac­tors. Actuarial sur­vi­val ­rate at 15 ­years is 33.5±6.9% (OM includ­ed). According to ­the com­par­i­son of ­the Actuarial Curves (Tests of Mantel ­and Breslow, OM exclud­ed) ­the ­most sig­nif­i­cant ­risk fac­tors ­were: ­non ­use of ­left inter­nal mam­mary ­artery (­LIMA) (p=0.004), VR (p=0.0l), ­TSD (p=0.03) ­and high­er ­NYHA ­class (p=0.019). Multivariate Analysis (Co Model) con­firms ­that ­late prog­no­sis is influ­enced by ­non ­use of ­LIMA (p=0.03) ­and ­TSD (p=0.04); out­come is ­also affect­ed by pre­op­er­a­tive arryhth­mi­as (p=0.022). Five-­year sur­vi­val ­after VR is 87.5±5.7% vs 64.9±5.5% ­after sim­ple lin­e­ar clo­sure or PL (p=0.1075 ­and p=0.2252). Our ­results con­firm ­that OM ­and LM are in­flu­enced by ­extent of myo­car­dial ischem­ic dam­age; in agree­ment ­with ­the major­ity of Authors we advo­cate a com­plete revas­cu­lar­iza­tion ­using ­IMA, ­when appro­pri­ate, on ­left ante­ri­or descend­ing ­artery. Our lim­it­ed expe­ri­ence ­with VR ­fails to dem­on­strate ­this tech­nique as an inde­pen­dent fac­tor of ­late sur­vi­val.

lingua: Inglese


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