What is the clinical evidence from this study?

Study design: Cohort. Population: Post-infarction left ventricular aneurysm (n=102). Intervention: Modified linear endoventricular patchplasty and linear repair. Primary outcome: Overall mortality.

October 1, 2008

Ventricular Restoration by Linear Endoventricular Patchplasty and Linear Repair

Key Result

Modified linear endoventricular patchplasty and linear repair in patients with post-infarction left ventricular aneurysm resulted in 12.7% overall mortality and increased LVEF from 31.5% to 34.2%.

Study Design

Type

Cohort (n=102)

Structured PICO

Does modified linear endoventricular patchplasty and linear repair improve cardiac function and geometry in patients with post-infarction left ventricular aneurysm?

Population

102 patients with post-infarction left ventricular aneurysm, treated between 2001 and 2004

Intervention

Modified techniques of both linear and geometric repair (linear endoventricular patchplasty and linear repair)

Outcome

Early and intermediate outcomes including mortality, left ventricular ejection fraction, end-diastolic volumes, and end-systolic volumes

Modified linear endoventricular patchplasty and linear repair for post-infarction left ventricular aneurysm significantly improves left ventricular ejection fraction and reduces ventricular volumes.

Abstract

Surgical ventricular restoration improves cardiac function in patients with large left ventricular aneurysms. Aneurysm repair techniques have evolved to geometric repair by exclusion of the aneurysmal area with a circular patch. But even circular endoventricular patchplasty may result in a less elliptical ventricle. We modified the techniques of both linear and geometric repair. The early and intermediate outcomes in 102 patients with post-infarction left ventricular aneurysm, treated between 2001 and 2004, were analyzed. Concomitant procedures included coronary artery bypass grafting in 73 patients, mitral valve repair in 29, cryoablation in 3, and post-infarction ventricular septal rupture repair in 3. Overall mortality was 12.7%. Left ventricular ejection fraction increased significantly postoperatively, from 31.5% +/- 6.5% to 34.2% +/- 5.9%. There were significant decreases in end-diastolic volumes from 140.3 +/- 38.3 to 100.8 +/- 33.5 mL, and end-systolic volumes from 95.1 +/- 26.1 to 66.0 +/- 21.7 mL. These benefits continued at the 12- to 52-month follow-up. Our modified technique restores a near physiological left ventricular geometry and has a favorable clinical outcome.

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