ORIGINAL ARTICLES  CARDIAC PAPERS 

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

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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.