Key result
Aneurysm resection resulted in significantly lower operative mortality compared to left ventricular plication (0% vs 37.5%, p<0.01) in patients requiring concurrent multiple coronary grafts.
Why the study?
Does left ventricular aneurysm surgery with multiple coronary grafts improve survival and symptoms in patients with LV aneurysm and diffuse coronary artery disease?
Cohort (n=35)
Does left ventricular aneurysm surgery with multiple coronary grafts improve survival and symptoms in patients with LV aneurysm and diffuse coronary artery disease?
Surgery for left ventricular aneurysm with multiple coronary grafts provides good symptomatic improvement and 5-year survival, with aneurysm resection showing significantly lower operative mortality than LV plication.
Answers are grounded in this paper and cite their sources.
Resection may be preferable to plication for lower mortality with multiple grafts; hypothesis-generating and requires prospective validation.
Because little information is available concerning the outcome of surgery for left ventricular aneurysm when multiple concurrent coronary grafts are required, we have reviewed 35 consecutive patients undergoing aneurysm surgery and multiple (greater than or equal to 3) grafts between December 1973 and April 1984. There were 6 operative deaths (17%). All occurred amongst those (16) undergoing LV plication procedures with no deaths amongst those (19) undergoing aneurysm resection (p less than 0.01). Operative mortality was not influenced by preoperative functional status, left ventricular end diastolic pressure, completeness of revascularisation, endarterectomy (13 patients) or whether cold crystalloid cardioplegia or intermittent aortic cross clamp with ventricular fibrillation was used. Overall 5-year actuarial survival was 70% with survival beyond surgery being 84% to 5 years and independent of the type of aneurysm procedure. Of the survivors, 16 were improved by 1-3 functional classes, 3 were unchanged and one was worse. Surgery in this group of patients offers the prospect of good symptomatic improvement and survival figures which at least equal the results of less complex ventricular aneurysm surgery and exceed those reported for medical management.
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Walker et al. (1988) conducted a cohort in Left ventricular aneurysm and diffuse coronary artery disease (n=35). Aneurysm resection vs. Left ventricular plication was evaluated on Operative mortality (p=<0.01). Aneurysm resection resulted in significantly lower operative mortality compared to left ventricular plication (0% vs 37.5%, p<0.01) in patients requiring concurrent multiple coronary grafts.
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