DEPT. OF CARDIOVASCULAR SURGERY, SHAHEED RAJAEE CARDIOCASCULAR MEDICAL CENTER, MELLAT PARK, VALI ASR AVE. TEHRAN, IRAN
Background- Over 95% of true left ventricular aneurysms result from coronary artery disease and myocardial infarction. The incidence of left ventricular aneurysm in patients suffering myocardial infarction has varied between 10-35%. Large left ventricular aneurysm can cause arrhythrnias, congestive heart failure, recurrent myocardial infarction, thromboembolic events and sudden death and operation is indicated for symptomatic large left ventricular aneurysms. In this study we evaluated results of surgical repair of left ventricular aneurysms in association with coronary artery bypass graft.
Methods- In this descriptive, cross-sectional study from September 1997 to March 2005, we had 1894 CABG operations. Concomitant left ventricular aneurysm repair was done in 54 cases.
Surgical complications, clinical findings, left ventricular ejection fraction, NYHA classes, morbidity and mortality were evaluated.
Results- NYHA classes were reduced from 3±0.7 preoperatively to 1.23±0.4 postoperatively (p<0.05), and left ventricular ejection fraction changed from 23.82±5.72% to 34. 12±7.25% (p<0.05). Surgical complications were reoperation for bleeding in 4 cases (7.4%), sternal dehiscence in 1 case (1.8%) and intra-aortic balloon pump insertion for weaning of CPB in 8 cases (14.8%). Mean ICD stay was 3±1.1 days, mean hospital stay was 13±2.3 days; hospital mortality was 1 case (1.8%). During follow up (1-5 years with a mean of 1±04), all patients are alive, free from cardiac events and have good functional classes.
Conclusion- Early and mid-term results of CABG with repair of left ventricular aneurysm are excellent with low morbidity and mortality, and we recommend CABG and repair of left ventricular aneurysm in case of large ventricular aneurysm.