Left Ventricular Aneurysm Repair: A Comparison of Linear Versus Patch Remodeling

Wei Yuan Chen, Fei Yi Wu, Chun Che Shih, Shiau Ting Lai, Chiao Po Hsu

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Surgical repair of left ventricular (LV) aneurysm has been performed for around 50 years. However, the most appropriate surgical approach remains undetermined. This study was undertaken to compare the efficacy of 2 established techniques, linear versus patch remodeling, for repair of dyskinetic LV aneurysms. Methods: We retrospectively reviewed the records of 49 patients (mean age, 69.8 ± 7.3 years) who had operation for postinfarction dyskinetic LV aneurysm between 1996 and 2006. Thirty-one patients underwent patch remodeling and 18 underwent linear repair. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. Results: Overall inhospital surgical mortality, major complications and early hemodynamics showed no significant differences between the 2 groups. During a mean follow-up of 44.0 ± 34.4 months, 8 patients died, with 4 due to cardiac-related causes. Actuarial survival rates at 1, 5 and 10 years were 85.7%, 69.9% and 45.7%, respectively. Functional class improved from 2.51 ± 0.59 to 1.66 ± 0.54 among the mid-term survivors (p < 0.001), with no significant difference between the 2 groups. Multivariate analysis identified preoperative NYHA functional class ≥ 3 as an independent risk factor for overall mortality (p = 0.008). Mid-term follow-up revealed that LV ejection fraction improved from 26.5 ± 7.2% to 34.1 ± 7.9% (p < 0.001) in the patch group, and from 26.3 ± 9.0% to 32.0 ± 9.2% in the linear group (p = 0.032). In contrast, right ventricular ejection fraction improved from 49.4 ± 10.1% to 52.0 ± 7.3% (p = 0.190) in the patch group, but deteriorated from 55.0 ± 6.3% to 50.3 ± 8.6% in the linear group (p = 0.029). Conclusion: These findings indicate that the 2 repair techniques have similar effectiveness with respect to short- and mid-term outcomes except for right ventricular ejection fraction. We suggest that the selection of repair technique for LV aneurysms should be individualized for each patient based on aneurysm size and extent of the scarring process into the septum and subvalvular mitral apparatus.

Original languageEnglish
Pages (from-to)414-421
Number of pages8
JournalJournal of the Chinese Medical Association
Volume72
Issue number8
DOIs
Publication statusPublished - Aug 1 2009
Externally publishedYes

Fingerprint

Aneurysm
Stroke Volume
Mortality
Hospital Mortality
Cicatrix
Survivors
Multivariate Analysis
Survival Rate
Hemodynamics

Keywords

  • dyskinetic aneurysm
  • left ventricular aneurysm
  • linear repair
  • patch repair
  • postinfarction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Left Ventricular Aneurysm Repair : A Comparison of Linear Versus Patch Remodeling. / Chen, Wei Yuan; Wu, Fei Yi; Shih, Chun Che; Lai, Shiau Ting; Hsu, Chiao Po.

In: Journal of the Chinese Medical Association, Vol. 72, No. 8, 01.08.2009, p. 414-421.

Research output: Contribution to journalArticle

@article{121ae1fd5e724cabb01a3959809dd029,
title = "Left Ventricular Aneurysm Repair: A Comparison of Linear Versus Patch Remodeling",
abstract = "Background: Surgical repair of left ventricular (LV) aneurysm has been performed for around 50 years. However, the most appropriate surgical approach remains undetermined. This study was undertaken to compare the efficacy of 2 established techniques, linear versus patch remodeling, for repair of dyskinetic LV aneurysms. Methods: We retrospectively reviewed the records of 49 patients (mean age, 69.8 ± 7.3 years) who had operation for postinfarction dyskinetic LV aneurysm between 1996 and 2006. Thirty-one patients underwent patch remodeling and 18 underwent linear repair. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. Results: Overall inhospital surgical mortality, major complications and early hemodynamics showed no significant differences between the 2 groups. During a mean follow-up of 44.0 ± 34.4 months, 8 patients died, with 4 due to cardiac-related causes. Actuarial survival rates at 1, 5 and 10 years were 85.7{\%}, 69.9{\%} and 45.7{\%}, respectively. Functional class improved from 2.51 ± 0.59 to 1.66 ± 0.54 among the mid-term survivors (p < 0.001), with no significant difference between the 2 groups. Multivariate analysis identified preoperative NYHA functional class ≥ 3 as an independent risk factor for overall mortality (p = 0.008). Mid-term follow-up revealed that LV ejection fraction improved from 26.5 ± 7.2{\%} to 34.1 ± 7.9{\%} (p < 0.001) in the patch group, and from 26.3 ± 9.0{\%} to 32.0 ± 9.2{\%} in the linear group (p = 0.032). In contrast, right ventricular ejection fraction improved from 49.4 ± 10.1{\%} to 52.0 ± 7.3{\%} (p = 0.190) in the patch group, but deteriorated from 55.0 ± 6.3{\%} to 50.3 ± 8.6{\%} in the linear group (p = 0.029). Conclusion: These findings indicate that the 2 repair techniques have similar effectiveness with respect to short- and mid-term outcomes except for right ventricular ejection fraction. We suggest that the selection of repair technique for LV aneurysms should be individualized for each patient based on aneurysm size and extent of the scarring process into the septum and subvalvular mitral apparatus.",
keywords = "dyskinetic aneurysm, left ventricular aneurysm, linear repair, patch repair, postinfarction",
author = "Chen, {Wei Yuan} and Wu, {Fei Yi} and Shih, {Chun Che} and Lai, {Shiau Ting} and Hsu, {Chiao Po}",
year = "2009",
month = "8",
day = "1",
doi = "10.1016/S1726-4901(09)70398-3",
language = "English",
volume = "72",
pages = "414--421",
journal = "Journal of the Chinese Medical Association",
issn = "1726-4901",
publisher = "Elsevier Taiwan LLC",
number = "8",

}

TY - JOUR

T1 - Left Ventricular Aneurysm Repair

T2 - A Comparison of Linear Versus Patch Remodeling

AU - Chen, Wei Yuan

AU - Wu, Fei Yi

AU - Shih, Chun Che

AU - Lai, Shiau Ting

AU - Hsu, Chiao Po

PY - 2009/8/1

Y1 - 2009/8/1

N2 - Background: Surgical repair of left ventricular (LV) aneurysm has been performed for around 50 years. However, the most appropriate surgical approach remains undetermined. This study was undertaken to compare the efficacy of 2 established techniques, linear versus patch remodeling, for repair of dyskinetic LV aneurysms. Methods: We retrospectively reviewed the records of 49 patients (mean age, 69.8 ± 7.3 years) who had operation for postinfarction dyskinetic LV aneurysm between 1996 and 2006. Thirty-one patients underwent patch remodeling and 18 underwent linear repair. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. Results: Overall inhospital surgical mortality, major complications and early hemodynamics showed no significant differences between the 2 groups. During a mean follow-up of 44.0 ± 34.4 months, 8 patients died, with 4 due to cardiac-related causes. Actuarial survival rates at 1, 5 and 10 years were 85.7%, 69.9% and 45.7%, respectively. Functional class improved from 2.51 ± 0.59 to 1.66 ± 0.54 among the mid-term survivors (p < 0.001), with no significant difference between the 2 groups. Multivariate analysis identified preoperative NYHA functional class ≥ 3 as an independent risk factor for overall mortality (p = 0.008). Mid-term follow-up revealed that LV ejection fraction improved from 26.5 ± 7.2% to 34.1 ± 7.9% (p < 0.001) in the patch group, and from 26.3 ± 9.0% to 32.0 ± 9.2% in the linear group (p = 0.032). In contrast, right ventricular ejection fraction improved from 49.4 ± 10.1% to 52.0 ± 7.3% (p = 0.190) in the patch group, but deteriorated from 55.0 ± 6.3% to 50.3 ± 8.6% in the linear group (p = 0.029). Conclusion: These findings indicate that the 2 repair techniques have similar effectiveness with respect to short- and mid-term outcomes except for right ventricular ejection fraction. We suggest that the selection of repair technique for LV aneurysms should be individualized for each patient based on aneurysm size and extent of the scarring process into the septum and subvalvular mitral apparatus.

AB - Background: Surgical repair of left ventricular (LV) aneurysm has been performed for around 50 years. However, the most appropriate surgical approach remains undetermined. This study was undertaken to compare the efficacy of 2 established techniques, linear versus patch remodeling, for repair of dyskinetic LV aneurysms. Methods: We retrospectively reviewed the records of 49 patients (mean age, 69.8 ± 7.3 years) who had operation for postinfarction dyskinetic LV aneurysm between 1996 and 2006. Thirty-one patients underwent patch remodeling and 18 underwent linear repair. Short-term and mid-term outcomes, including complications, cardiac function and mortality, were assessed. Results: Overall inhospital surgical mortality, major complications and early hemodynamics showed no significant differences between the 2 groups. During a mean follow-up of 44.0 ± 34.4 months, 8 patients died, with 4 due to cardiac-related causes. Actuarial survival rates at 1, 5 and 10 years were 85.7%, 69.9% and 45.7%, respectively. Functional class improved from 2.51 ± 0.59 to 1.66 ± 0.54 among the mid-term survivors (p < 0.001), with no significant difference between the 2 groups. Multivariate analysis identified preoperative NYHA functional class ≥ 3 as an independent risk factor for overall mortality (p = 0.008). Mid-term follow-up revealed that LV ejection fraction improved from 26.5 ± 7.2% to 34.1 ± 7.9% (p < 0.001) in the patch group, and from 26.3 ± 9.0% to 32.0 ± 9.2% in the linear group (p = 0.032). In contrast, right ventricular ejection fraction improved from 49.4 ± 10.1% to 52.0 ± 7.3% (p = 0.190) in the patch group, but deteriorated from 55.0 ± 6.3% to 50.3 ± 8.6% in the linear group (p = 0.029). Conclusion: These findings indicate that the 2 repair techniques have similar effectiveness with respect to short- and mid-term outcomes except for right ventricular ejection fraction. We suggest that the selection of repair technique for LV aneurysms should be individualized for each patient based on aneurysm size and extent of the scarring process into the septum and subvalvular mitral apparatus.

KW - dyskinetic aneurysm

KW - left ventricular aneurysm

KW - linear repair

KW - patch repair

KW - postinfarction

UR - http://www.scopus.com/inward/record.url?scp=70449417967&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70449417967&partnerID=8YFLogxK

U2 - 10.1016/S1726-4901(09)70398-3

DO - 10.1016/S1726-4901(09)70398-3

M3 - Article

C2 - 19686997

AN - SCOPUS:70449417967

VL - 72

SP - 414

EP - 421

JO - Journal of the Chinese Medical Association

JF - Journal of the Chinese Medical Association

SN - 1726-4901

IS - 8

ER -