Surgery of left ventricular aneurysm: a propensity score-matched study of outcomes following different repair techniques

Abstract

To evaluate early and late outcomes of modified left ventricular reconstruction (VR) and linear repair (LR) of post-infarct left ventricular aneurysm (LVA). A total of 514 patients were consecutively operated on for LVA with modified VR technique in 145 and LR in 352 patients. Using the propensity score-matching method, we selected 202 patients (101 LRs vs. 101 VRs) with similar pre- and intra-operative characteristics and compared their clinical outcomes. After matching, the two groups of patients were similar with regard to baseline data. The increment of left ventricular ejection fraction (LVEF) in VR group was more significant than that in LR group. Operative mortality was 2.0% (2.0% LRs vs. 2.0% VRs, P=NS). There was a statistically significant difference between LR and VR patients in MACCEs (29.7% LRs vs. 13.9% VRs, P<0.01) and hospital readmissions (51.5% LRs vs. 30.7% VRs, P<0.01). Overall long-term mortality and cardiac mortality were the same between the two groups (mortality: 11.9% LRs vs. 11.9% VRs, P=NS; cardiac mortality: 9.9% LRs vs. 7.9% VRs, P=NS). The technique of repairing LVA did not affect the early and later mortality.

Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms

“…Zheng et al. [ 20 ] also reported that the mean postoperative EF value increased more in patients who underwent Dor procedure than patients who underwent linear repair. They suggested that this was because Dor procedure preserved the conical shape of the LV and caused a positive remodeling.…”

“…Furthermore, in the early postoperative period, only three (3.3%) patients were lost and only two (2.2%) died at one year of follow-up, and the absence of anginal pain in 93% supports our hypothesis. Zheng et al [ 20 ] also showed that the IABP insertion rate was 5.5% (n=8) in the Dor group and 4.8% (n=17) in the linear repair group, indicating no significant difference between the groups. In our patients, the IABP insertion rate was 12.5% (n=6) in group A and 5% (n=2) in group B.…”

The Value of Aneurysm Volume and Myocardial Strain Rate for Evaluating Cardiac Function of Ischemia‐Related Left Ventricular Aneurysm in a Rabbit Model Using Real Time Three‐Dimensional Echocardiographic Imaging Combined with Speckle Tracking Imaging

“…The unfavorable remodeling results in increased left ventricular end-diastolic pressureload and volume-load, as well as left ventricular enlargement, which subsequently leads to low cardiac output and accelerates the occurrence of cardiac insufficiency. 19,20 2D-STI allows angleindependent evaluation of myocardial strain and the strain rates in the radial, circumferential, and longitudinal directions, providing comprehensive information on left ventricular myocardial contractility. 21,22 RT-3DE has broken the limitations of 2D echocardiographic findings based on the assumptions about left ventricular cavity geometry.…”

“…The rabbit model of LVA was prepared by ligation of the middle segment of the left anterior descending artery and the left circumflex artery as described previously. 19 Briefly, rabbits were first anesthetized with intravenous pentobarbitone sodium (30 mg). A thoracotomy was performed through the left fourth intercostal space, and the left anterior descending artery and left circumflex artery were permanently ligated in the middle segment by a 5.0 silk suture.…”

The Value of Myocardial Torsion and Aneurysm Volume for Evaluating Cardiac Function in Rabbit with Left Ventricular Aneurysm

“…Rabbits were anesthetized with pentobarbitone sodium (30 mg/kg IV). Rabbit models of LVA were prepared by ligation of the middle segment of the left anterior descending artery and left circumflex artery, as previously described [ 25 ]. Preoperative intravenous lidocaine was administered to prevent arrhythmia and intravenous heparin was used for prophylaxis of venous thrombosis.…”