Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short- and long-term results in ischemic cardiomyopathy

Abstract

INTRODUCTION:The purpose of this study was to (1) identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and (2) identify predictors of favorable outcomes.METHODS AND MATERIAL:Patients (n = 169) with angiographic left ventricular ejection fraction of 22±5% underwent aneurysm surgery and were prospectively followed for three years. Prior to surgery, 40% and 60% of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively. Concomitant revascularization was performed on 95% of the patients.RESULTS:Cumulative in‐hospital and 36‐month mortalities were 7% and 15%, respectively. These respective rates varied according to preoperative parameters: CHF class I‐II, 4% and 13%; CHF class III‐IV, 8% and 16%; LVEF<20%, 12% and 26%; LVEF 21‐30%, 2% and 6%; gated LVEF exercise/rest >5%, <1% and 4%; and gated LVEF exercise/rest ≤5%, 17% and 38%. Higher LVEF ex/rest ratio (p = 0.01), male sex (p = 0.05), and a higher number of grafts (p = 0.01) were predictive of improvement in CHF class at follow‐up based on the results of a multivariate analysis. After three years of follow‐up, 84% of the patients were in class I/II, LVEF was 45±7%, and gated LVEF ex/rest ratio was 13% higher (p<0.01) compared to the beginning of the study.CONCLUSIONS:These data suggest that aneurysmectomy among patients with severe LV dysfunction result in short‐ and long‐term favorable functional outcome and survival. Selection of appropriate surgical candidates may substantially improve survival rates among these patients.

Cardiology in Brazilian scientific journals: an overview

“…Four articles on vascular surgery have been selected, Serrano et al [19] endeavored to identify the functional results after aneurysm surgery in patients with ischemic cardiomyopathy and to determine predictors of favorable outcomes in 169 patients with angiographic left ventricular ejection fraction of 22 ± 5%, who underwent aneurysm surgery, and were prospectively followed for three years. Prior to surgery, 40% and 60% of the patients were in congestive heart failure NYHA class I/II and III/IV, respectively.…”

Mending the broken valentine heart: a case report

“…A 2010 study showed short- and long-term survival benefit and NYHA classification improvement with an almost 90% survival in patients with initially severe LV impairment at 3 years compared with previous documented 5 year survival of up to 73% in revascularized patients only. 11 In this particular case the patient, had been discussed in a MDT and it was felt given the large aneurysm with a large thrombus and the patients continuous refractory symptoms of heart failure indicated he would benefit from LV aneurysmectomy. Ultimately this form of management should be considered and discussed in an MDT when faced with patients that exhibit a large aneurysm associated with a large LV thrombus despite optimal medical care.…”