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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 1998 August;39(4):461-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Linear repair versus ventricular reconstruction for treatment of left ventricular aneurysm: a 10-year experience

Vicol C., Rupp G., Fischer S.*, Summer Ch.*, Dietrich Bolte H.*, Struck E.

From the Clinic of Cardiac Surgery and the *First Medical Clinic, Central Hospital, Augsburg, Germany


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Objective. To ­describe a 10-­year expe­ri­ence ­with sur­gi­cal treat­ment of ­left ven­tric­u­lar aneu­rysm and com­pare the ­results of lin­e­ar ­repair and ven­tric­u­lar recon­struc­tion.
Design. A ret­ro­spec­tive ­data anal­y­sis.
Setting. Department of car­di­oth­o­rac­ic sur­gery.
Patients. All ­patients treat­ed ­with con­cur­rent cor­o­nary ­artery ­bypass revas­cu­lar­iza­tion and sur­gi­cal ­repair of ven­tric­u­lar aneu­rysm from 1985 to 1995.
Methods. Patients under­went ­either lin­e­ar ­repair ­after aneu­rys­mec­to­my (­group A; n=51) or recon­struc­tion of the ­left ven­tri­cle ­using a ­patch (­group B, n=10). Preoperative ­patient char­ac­ter­is­tics and post­op­er­a­tive mor­tal­ity and symp­to­mat­ic ­results in the two ­groups ­were com­pared ­with χ2 and ­paired “t”-­tests.
Results. The ear­ly mor­tal­ity ­rates ­were 9.8% over­all, 7.8%, in ­group A, and 20% in ­group B. During a ­mean fol­low-up of 58 ­months, the ­late mor­tal­ity ­rates ­were 34.5%, 38.2%, and 12.5%. In com­par­i­son to ­patients in ­group A, ­those in ­group B had high­er pre­op­er­a­tive ­rates of seri­ous­ly ­impaired ­left ven­tric­u­lar ejec­tion frac­tion (p=0.01) and path­o­log­ic ­left ven­tric­u­lar end-dia­stol­ic pres­sure (p=0.03) and a pro­longed oper­a­tive aor­tic ­cross-­clamp ­time (p=0.04). Early mor­tal­ity in ­group B may ­have ­been influ­enced by the initial­ly ­impaired hemo­dy­nam­ic func­tion and the ­cross-­clamp ­time. In the ­long­term, ­patients in ­group B had ­more symp­to­mat­ic improve­ment ­than ­those in ­group A (p=0.02).
Conclusions. Ventricular func­tion in ­patients ­with ­left ven­tric­u­lar aneu­rysm ­improved ­after ven­tric­u­lar recon­struc­tion ­using a ­patch. Further expe­ri­ence ­with ­this pro­ce­dure ­should ­improve post­op­er­a­tive sur­vi­val and ­long-­term prog­no­sis.

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