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Surgery for left ventricular aneurysm after myocardial infarction： techniques selection and results assessment

Chinese Medical Journal 2012年第24期125卷 4373-4379页

作者： CHEN Xin QIU Zhi-bing XU Ming LIU Le-le JIANG Ying-shuo WANG Li-ming Department of Thoracic & Cardiovascular Surgery Nanjing First Hospital Nanjing Medical University Nanjing Heart Institute Nanjing Jiangsu 210006 China

Background The most appropriate surgical approach for patients with post-infarction left ventricular （LV） aneurysm remains undetermined. We compared the efficacy of the linear versus patch repair techniques, and investigated the mid-term changes of LV geometry and cardiac function, for repair of LV aneurysms. Methods We reviewed the records of 194 patients who had surgery for a post-infarction LV aneurysm between 1998 and 2010. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. LV end-diastolic and systolic dimensions （LVEDD and LVESD）, LV end-diastolic and end-systolic volume indexes （LVEDVI and LVESVI） and LV ejection fraction （LVEF） were measured on pre-operative and follow-up echocardiography. Results Overall in-hospital mortality was 4.12%, and major morbidity showed no significant differences between the two groups. Multivariate analysis identified preoperative left ventricular end diastolic pressure 〉20 mmHg, low cardiac output and aortic clamping time 〉2 hours as risk factors for early mortality. Follow-up revealed that LVEF improved from 37% pre-operation to 45% 12 months post-operation in the patch group （P=0.008）, and from 44% pre-operation to 40% 12 months postoperation in the linear group （P=0.032）. In contrast, the LVEDVI and LVESVI in the linear group were significantly reduced immediately after the operation, and increased again at follow-up. However, in the patch group, the LVEDVI and LVESVI were significantly reduced at follow-up. And there were significant differences in the correct value changes of LVEF and left ventricular remodeling between linear repair and patch groups. Conclusions Persistent reduction of LV dimensions after the patch repair procedure seems to be a procedure-related problem. The choice of the technique should be tailored on an individual basis and surgeon＇s preference. The patch remodeling technique results in a better LVEF improvement, further significant reductions in L

关键词： left ventricular aneurysm post-infarction linear repair patch remodeling left ventricular remodeling

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