Results of left ventricular aneurysmectomy with a tailored scar excision and primary closure technique.

Abstract

Controversy exists concerning which surgical technique is optimal for ventricular aneurysm repair. In 92 (97%) of 95 patients, we tailored scar excision to remove nonfunctioning wall and restore left ventricular geometry and shape toward normal while allowing linear closure. Preoperative and/or postoperative multiple gated acquisition scans were obtained in 76 (83%) of 92 patients and Doppler echocardiograms in 79 (86%) of 92. Before operation 78 patients (85%) were in New York Heart Association class III or IV with congestive heart failure in 58 (63%), angina in 69 (75%) and syncope in 46 (50%) of the 92 patients. Additional operative procedures included aorta-coronary bypass grafting in 81 patients (88%), septoplasty in 4 (4%), and arrhythmia ablation in 54 (59%). Hospital mortality was 3 (3%) of 92 patients. There have been 15 late deaths caused by congestive heart failure with or without mitral regurgitation (7 of 15). Among survivors 66 (89%) of 74 were symptomatically improved with 25 (34%) of 74 in New York Heart Association class I, 24 (32%) of 74 in class II, 19 (26%) of 74 in class III, and 6 (8%) of 74 in class IV. Actuarial survival was 88%, 86%, and 80% at 1, 2, and 5 years, respectively, and was not different for patients with a preoperative left ventricular ejection fraction less than 20%. In 47 patients with an anterior aneurysm who had preoperative and postoperative studies, multiple gated acquisition scans showed improvement in left ventricular ejection fraction from 23% to 30% (p < 0.001). Preoperative Doppler echocardiograms showed significant mitral regurgitation (2+ or more) in 26 (36%) of 72 patients studied. Of these, 21 had postoperative studies and mitral regurgitation was improved by at least one grade in 12 (57%) of 21 patients. We conclude that aneurysm repair with a tailored scar excision and linear closure is associated with low operative mortality, objective evidence of improvement in left ventricular function, symptomatic relief, and long-term survival even in patients with advanced left ventricular dysfunction and mitral regurgitation.