OUTCOME AND VENTRICULAR REMODELING IN PATIENTS UNDERGOING LEFT VENTRICULAR ANEURYSM REPAIR. COMPARISON BETWEEN TECHNIQUES

The aim of the study was to analyze the early and mid term outcome after postinfarction left ventricular aneurysm repair and to identify predictors for poor overall outcome. Materials and Methods: We retrospectively reviewed the records of 90 patients who had an operation for postinfarction left ventricular aneurysm between 1999 and 2012. 22 patients underwent repair of left ventricular aneurysm in Tirana, Albania, as an initial experience between 2005–2012. Independent risk factors were identified by logistic regression and Cox regression methods. Mean follow-up was 3.8 years (range, 6 months to 12 years). Clinical outcomes and echocardiographic measurements of left ventricular volume and sphericity in 52 patients who underwent endoventricular patch plasty were compared with those in 38 patients who had linear repair. Results: The early mortality (<30 days) rate was 3.3% (3 patients) altogether, and the 5-year cumulative survival rate was 70%. Associated procedures were mitral valve replacement 5n 11 patients, mitral valve repair in 8 patients, posterior-basal LV aneurysm in 5, more than 2 LV aneurysm at the same patient in one case, postinfarction anterior VSD in 2, postinfarction inferior VSD in 2 and RV aneurysm in 1. Advanced age, history of ventricular arrhythmia, three-vessel disease, low LVEF, coronary endarterectomy were independent risk factors for early and total mortality. At 6 months after surgery, the LVEF improved significantly (p=0.002), LVEDD (p=0.003) and NYHA (p=0.001). Postoperative functional improvement was significantly better in the endoventricular patch plasty group within 6 months after surgery: At follow-up there were no measurable differences between the groups with respect to left ventricular ejection fraction (0.38±0.10 versus 0.39±0.09; p = ns). Conclusions: Postinfarction left ventricular aneurysm can be repaired with acceptable surgical risk and long-term survival. Non substantial differences were offered by the endoventricular patch plasty technique.