Left ventricular aneurysmectomy; comparison between two techniques; early and late results
| Autor: | Benedetto Marino, Giampaolo Luzi, Giovanni Ruvolo, Riccardo Sinatra, Giovanni Melina, Francesco Macrina, Maurizio Braccio |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Heart disease Myocardial Infarction Hemodynamics Anterior Descending Coronary Artery Group A Group B Ventricular Function Left Aneurysm Postoperative Complications Internal medicine medicine Humans Cardiac Surgical Procedures Heart Aneurysm Aged Retrospective Studies Ejection fraction business.industry General Medicine Middle Aged medicine.disease Prognosis Surgery Survival Rate Left Ventricular Aneurysm Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 12(2) |
| ISSN: | 1010-7940 |
| Popis: | Objective: The aim of the present study was to evaluate early and late results of two different surgical techniques for left ventricular aneurysms repair. The conventional aneurysmectomy and direct closure of the ventricular wall and the endoventricular patch plasty. Methods: We retrospectively reviewed 118 patients operated on for postinfarction left ventricular aneurysm from 1981 to 1994. Eighty-seven patients (Group A) were operated upon between 1981 and 1991 with the conventional technique and 31 patients (Group B) between 1992 and 1994 with the endoventricular patch plasty technique. Preoperative clinical, hemodynamic and echocardiographic evaluation with operative procedures and early postoperative results of all patients are reported. We also analyzed results of late clinical and echocardiographic controls of 34 patients of Group A and all patients of Group B after a mean follow-up of 42 and 28 months, respectively. Results: Mean number of by-pass grafts was 1.9 in Group A and 2.6 in Group B (P0.01). The left anterior descending coronary artery was revascularized in 27 patients of Group A (34.6%) and 26 of Group B (89.7%) (PB0.001); the left internal mammary artery was used in seven patients of Group A (8.9%) and 24 of Group B (82.8%) (PB0.001). Hospital mortality in Group A was 10.3% (9:87), in Group B there was no hospital mortality (P\0.05). Thirty-two patients of Group A (36.8%) and 3 of Group B (9.7%) suffered of low cardiac output syndrome (P 0.01). At late control, improvements observed in NYHA and CCS classes, left ventricular ejection fraction (all PB 0.001 in both groups versus preoperative values) and left ventricular end-diastolic diameter (P\ 0.05 in Group A and PB 0.001 in Group B) proved to be statistically higher in patients of Group B. Conclusions: Endoventricular patch plasty associated with a complete myocardial revascularization, in particular of the anterior descending coronary, and a larger use of the internal mammary artery, permits, by means of reconstruction of the left ventricular geometry, a better outcome for patients undergoing left ventricular aneurysmectomy. © 1997 Elsevier Science B.V. |
| Databáze: | OpenAIRE |
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