Surgical treatment of left ventricular post-infarction aneurysm with endoventriculoplasty

Late clinical and functional results

Daniel Giorgio Di Mattia, Pietro Di Biasi, Maurizio Salati, Andrea Mangini, Pino Fundarò, Carmine Santoli

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: The temporal response to endoventriculoplasty (EVP) has not been well defined. We have evaluated the long-term clinical and functional results of this technique. Methods: From 1988 to 1997, 121 patients underwent aneurysmectomy by EVP associated with myocardial revascularization for anteroapical left ventricular postinfarction aneurysm. Among these, 39 patients (43%) underwent early post-operative cardiac catheterization (within 3 months maximum), and were available to be revaluated after a mean follow- up time of 56 ± 28 months, by means of a new hemodynamic study. Left ventricular silhouettes were analyzed by means of a special software. Results: The mean New York Heart Association functional class decreased from 2.5 ± 0.9 to 1.6 ± 0.8 (P <0.001) late postoperatively. The global ejection fraction improved early postoperatively from 43 ± 13 to 61 ± 13% (P <0.001), and late postoperatively slightly decreased to 42 ± 13% (ns) versus preoperative values. Left ventricular end diastolic pressure early postoperatively fell from 16.8 ± 7 to 15.7 ± 6.7 (ns), and late postoperatively increased to 21.6 ± 8.8 (ns) versus preoperative values. Pulmonary artery pressure rose early postoperatively from 31.5 ± 6.4 to 32.1 ± 6.7 (ns), and late postoperatively to 34.9 ± 8.9 (ns). The global contractility score decreased early postoperatively from 42.3 ± 9.6 to 28.4 ± 13.6 (P <0.001); the global late postoperative contractily was 35 ± 14 (ns) versus preoperative values. Patients who benefit most from the operation were those with a normal postoperative contraction pattern, where ejection fraction improved respectively early postoperatively from 43 ± 13 to 63 ± 11% (P <0.001), and late postoperatively to 49 ± 10% (P <0.001) versus preoperative values. Occlusion or critical stenosis of bypass grafts occurred in 10 patients (25.6%). There were no significant differences in hemodynamic data and hypokinesis score changes between patients with patent or occluded bypass graft, and between patients with mono or multivessel disease. The operative mortality was 6.3%, and 8.8% needed intraaortic balloon counterpulsation. The actuarial survival rates at 5 and 7 years were 73 ± 6 and 61 ± 6%. The mean follow-up period was 68 months (with 112 months maximum). Conclusions: We conclude that, in our patients group, EVP of left ventricular aneurysm associated with coronary grafting improves clinical status after operation. We registered a trend for a mild hemodynamic worsening, irrespective of coronary artery disease except in those patients who had shown a normal postoperative contraction pattern.

Original languageEnglish
Pages (from-to)413-418
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume15
Issue number4
DOIs
Publication statusPublished - Apr 1 1999

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Infarction
Aneurysm
Hemodynamics
Therapeutics
Counterpulsation
Transplants
Myocardial Revascularization
Cardiac Catheterization
Pulmonary Artery
Coronary Artery Disease
Pathologic Constriction
Software
Survival Rate
Blood Pressure
Pressure
Mortality

Keywords

  • Endoventriculoplasty
  • Left ventricular aneurysm
  • Left ventricular geometry
  • Long-term results

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Surgical treatment of left ventricular post-infarction aneurysm with endoventriculoplasty : Late clinical and functional results. / Di Mattia, Daniel Giorgio; Di Biasi, Pietro; Salati, Maurizio; Mangini, Andrea; Fundarò, Pino; Santoli, Carmine.

In: European Journal of Cardio-thoracic Surgery, Vol. 15, No. 4, 01.04.1999, p. 413-418.

Research output: Contribution to journalArticle

Di Mattia, Daniel Giorgio ; Di Biasi, Pietro ; Salati, Maurizio ; Mangini, Andrea ; Fundarò, Pino ; Santoli, Carmine. / Surgical treatment of left ventricular post-infarction aneurysm with endoventriculoplasty : Late clinical and functional results. In: European Journal of Cardio-thoracic Surgery. 1999 ; Vol. 15, No. 4. pp. 413-418.
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abstract = "Objective: The temporal response to endoventriculoplasty (EVP) has not been well defined. We have evaluated the long-term clinical and functional results of this technique. Methods: From 1988 to 1997, 121 patients underwent aneurysmectomy by EVP associated with myocardial revascularization for anteroapical left ventricular postinfarction aneurysm. Among these, 39 patients (43{\%}) underwent early post-operative cardiac catheterization (within 3 months maximum), and were available to be revaluated after a mean follow- up time of 56 ± 28 months, by means of a new hemodynamic study. Left ventricular silhouettes were analyzed by means of a special software. Results: The mean New York Heart Association functional class decreased from 2.5 ± 0.9 to 1.6 ± 0.8 (P <0.001) late postoperatively. The global ejection fraction improved early postoperatively from 43 ± 13 to 61 ± 13{\%} (P <0.001), and late postoperatively slightly decreased to 42 ± 13{\%} (ns) versus preoperative values. Left ventricular end diastolic pressure early postoperatively fell from 16.8 ± 7 to 15.7 ± 6.7 (ns), and late postoperatively increased to 21.6 ± 8.8 (ns) versus preoperative values. Pulmonary artery pressure rose early postoperatively from 31.5 ± 6.4 to 32.1 ± 6.7 (ns), and late postoperatively to 34.9 ± 8.9 (ns). The global contractility score decreased early postoperatively from 42.3 ± 9.6 to 28.4 ± 13.6 (P <0.001); the global late postoperative contractily was 35 ± 14 (ns) versus preoperative values. Patients who benefit most from the operation were those with a normal postoperative contraction pattern, where ejection fraction improved respectively early postoperatively from 43 ± 13 to 63 ± 11{\%} (P <0.001), and late postoperatively to 49 ± 10{\%} (P <0.001) versus preoperative values. Occlusion or critical stenosis of bypass grafts occurred in 10 patients (25.6{\%}). There were no significant differences in hemodynamic data and hypokinesis score changes between patients with patent or occluded bypass graft, and between patients with mono or multivessel disease. The operative mortality was 6.3{\%}, and 8.8{\%} needed intraaortic balloon counterpulsation. The actuarial survival rates at 5 and 7 years were 73 ± 6 and 61 ± 6{\%}. The mean follow-up period was 68 months (with 112 months maximum). Conclusions: We conclude that, in our patients group, EVP of left ventricular aneurysm associated with coronary grafting improves clinical status after operation. We registered a trend for a mild hemodynamic worsening, irrespective of coronary artery disease except in those patients who had shown a normal postoperative contraction pattern.",
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AU - Di Biasi, Pietro

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AU - Fundarò, Pino

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