EARLY HEMODYNAMIC-RESULTS OF LEFT-VENTRICULAR RECONSTRUCTIVE SURGERY FOR ANTERIOR WALL LEFT-VENTRICULAR ANEURYSM

To assess the efficacy of left ventricular (LV) reconstruction after aneurysmectomy, 35 consecutive patients with anterior LV aneurysm were studied before and after surgery. Surgical technique was performed by applying a circular patch after aneurysmectomy to maintain a "more physiological" LV cavity. Myocardial revascularization was performed in all but 1 patient concurrently. Global perioperative mortality was 4.8%. LV filling pressure and volumes and regional wall motion were assessed before and after surgery. The major indication for surgery was angina; 8 patients were in New York Heart Association class III/IV. The results showed a significant decrease in end-diastolic volume index (from 120 +/- 55 ml/m2 to 76 +/- 22 ml/m2, p < 0.001), end-systolic volume index (from 74 +/- 44 ml/m2 to 40 +/- 18 ml/m2, p < 0.001) and end-diastolic pressure (from 17 +/- 7 mm Hg to 13 +/- 5 mm Hg, p < 0.05). Ejection fraction significantly increased (from 39 +/- 13% to 49 +/- 15%, p < 0.001). LV wall motion significantly improved in all but the anterobasal region; the extent of LV asynergy significantly decreased after surgery. Six of the 35 patients had a deterioration of postintervention ejection fraction (from 44 +/- 14% to 34 +/- 9%). They had no reduction in LV volumes and no improvement in wall kinetics. It is concluded that LV reconstruction after aneurysmectomy induces significant early improvement of global and regional LV function in most patients; postoperative functional improvement is mainly related to the increase in inferior LV wall motion.