Predictors for poor overall outcome in patients undergoing left ventricular aneurysm repair. Comparison between endoventricular patch plasty and linear repair

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. Simple linear resection and endoventricular patch plasty are alternative techniques to repair postinfarction left ventricular aneurysm. A second objective of the study was to compare these 2 methods with regard to early and mid term outcome. Materials and Methods. We retrospectively reviewed the records of 87 patients who had an operation for postinfarction left ventricular aneurysm between 1999 and 2011. 19 patients underwent repair of left ventricular aneurysm in Tirana, Albania, as an initial experience between 2005-2011. The following variables were recorded: preoperative clinical, angiographic, and echocardiographic findings and operative procedures. Outcomes were early mortality (<30 days) and mid-term survival. Risk factors were pinpointed using t test or Mann-Whitney test, contingency tables, and survival curves. 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 35 patients who had linear repair. Results: The early mortality (<30 days) rate was 3.4% (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. Poor left ventricular function predicted reduced long-term survival but did not increase surgical risk. The two groups according the surgical procedure were matched with respect to age, gender, comorbid risk factors, functional class, urgency of the operation, and concomitant procedures. Postoperaticve functional improvement was significantly better in the endoventricular patch plasty group within 6 months after surgery: At followup there were no measurable differences between the groups with respect to left ventricular ejection fraction (0.33 ± 0.12 versus 0.30 ± 0.09; p = ns). Conclusions: Postinfarction left ventricular aneurysm can be repaired with acceptable surgical risk and long-term survival. Survival is reduced in cases with advanced age, history of ventricular arrhythmia, three-vessel disease, poor left ventricular function, and coronary endarterectomy. Non substantial differences were offered by the endoventricular patch plasty technique.