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Surgical treatment of postinfarction anterior left ventricular aneurysms: linear vs. patch plasty repair

^a V. Vakhidov Research Centre of Surgery, Tashkent, Uzbekistan
^b Department of Thoracic and Cardiovascular Surgery, CHU Arnaud de Villeneuve Hospital, 371, avenue du Doyen G. Giraud, 34295 Montpellier Cedex, France

*Corresponding author. Tel.: +33-4-67-33-62-72; fax: +33-4-67-33-62-75.

E-mail address: jm-frapier{at}chu-montpellier.fr (J.-M. Frapier).

Background: The patch plasty repair is increasingly advocated over linear closure in the surgical treatment of postinfarction anterior left ventricular aneurysm (LVA). A comparative estimate of the clinical results of these two techniques seemed in order. Methods: Between 1985 and 2004, 53 patients (mean age of 64.2±8.3 years) underwent repair of anterior LVA. Twenty-seven patients underwent linear repair (group 1) and 26 patients patch plasty (group 2). The mean left ventricular ejection fraction was 33.9±8.2% in group 1 vs. 29.7±10.2% in group 2 (P=0.118). Preoperatively 85.2% of patients in group 1 were in NYHA functional class III or IV vs. 88.5% in group 2 (P=0.71). All patients had preoperative recurrent ventricular tachycardia (VT) and non-guided encircling cryoablation for treatment of VT was performed in all patients. Coronary revascularization was performed in 29.6% of patients in group 1 and 42.3% in group 2 (P=0.398). Results: The overall in-hospital mortality was 1.9% as one patient died of low cardiac output (LCO). LCO was the most frequent early postoperative complication and was observed in 66.7% of patients in group 1 vs. 65.4% in group 2 (P=1.000). LCO was related to right coronary artery disease on multivariate analysis (odds ratio 6.9, P=0.0097). Mean follow-up was 6.4±4.8 years (range 1 day–17.5 years). Overall survival at 10 years was 65.5% of patients in group 1 vs. 60.6% in group 2 (P=0.395). At 10 years, 91.5% of patients were free from VT or sudden death in group 1 vs. 81% in group 2 (P=0.269). At follow-up the patients' functional status improved and among survivors 76.9% in group 1 were in NYHA functional class I–II vs. 62.5% in group 2 (P=0.432). Deaths from congestive heart failure (CHF) occurred in 38.5% of patients in group 1 vs. 55.6% in group 2 (P=0.632). On multivariate analysis a preoperative left ventricular end-diastolic pressure above 20 mmHg was a predictor of mortality from CHF (odds ratio 9.6, P=0.038). Conclusions: Our study did not reveal significant differences between linear closure and patch plasty repair in the short- and long-term. The choice of repair technique should be adapted to each patient's anatomical and physiological characteristics.

Key Words: Postinfarction; Left ventricular aneurysm; Linear repair; Patch plasty; Ventricular tachycardia; Cryoablation