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(Circulation. 1995;92:98-100.)
© 1995 American Heart Association, Inc.

Articles

Endoventricular Remodeling of Left Ventricular Aneurysm

Functional, Clinical, and Electrophysiological Results

Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994, and published in abstract form (Circulation. 1994;90[pt 2]:I-640).

Eugene A. Grossi, MD; Larry A. Chinitz, MD; Aubrey C. Galloway, MD; Julie Delianides, MA; Daniel S. Schwartz, MD; David E. McLoughlin, MD; Norma Keller, MD; Itzhak Kronzon, MD; Frank C. Spencer, MD; Stephen B. Colvin, MD

From the Divisions of Cardiothoracic Surgery and Cardiology (L.A.C., I.K., N.K.), Departments of Surgery and Medicine, New York University Medical Center, New York City.

Correspondence to Eugene A. Grossi, MD, New York University Medical Center, 530 First Ave, Suite 6D, New York, NY 10016.E-mail grossi@acf.nyu.edu.

Background Recent advances in surgical techniques for the repair of left ventricular aneurysms (LVAs) include the use of an endoventricular patch to exclude the aneurysm cavity. This technique has replaced conventional linear plication of the aneurysm. The endoventricular patch technique remodels the left ventricular cavity to a more physiological geometry that improves function.

Methods and Results From December 1989 through November 1993, 45 patients underwent an LVA repair with an endoventricular patch. This procedure was performed in association with coronary artery bypass grafting in 40 patients. Twenty-eight patients (62.2%) also had nonguided encircling subendocardial incisions. Operative procedures included 7 emergency operations, 3 concomitant valve procedures, and a mean of 2.2 bypass grafts per patient. Eight patients had previous cardiac operations. Hospital mortality was 15.6% (7/45) for all patients and 9.1% (3/33) for nonemergent revascularization and LVA repairs. Ejection fraction improved from a mean of 25.8% preoperatively to 37.8% postoperatively; the mean New York Heart Association classification improved from 3.5 to 1.5. Of patients known to have preoperative arrhythmias (inducible or sudden death), 69% were not inducible postoperatively without antiarrhythmic medication. Survival from late cardiac death (including death of unknown origin) was 86.5% at 2 years. Freedom from documented ventricular arrhythmias was 94.3% at 2 years.

Conclusions These results indicate that the patch endoaneurysmorrhaphy technique can provide an excellent functional and physiological outcome in patients with LVAs and severely impaired ventricular function.

Key Words: aneurysm • remodeling • physiology

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