Resection of left ventricular aneurysm. Report of 277 patients.
The prognosis of patients with LVA (left ventricular aneurysm) treated medically has been uniformly poor. Surgical resection of the ventricular aneurysm has been the treatment of choice at the Texas Heart Institute since 1958. A more accurate evaluation of patients with LVA by selective coronary arteriography has demonstrated significant associated CAD in over 75 percent of these patients. Since 1969, 125 patients with at lease one vessel suitable for bypass (group II) have undergone single, double or triple ACB in association with LVA resection; and 51 patients (group III) without significant conc-omitant CAD underwent LVA resection alone. To evaluate the efficacy of combined ACB and LVA resection, patients in group II and group III were compared to a third group of 101 patients who underwent LVA resection alone from 1958 to 1969 (group I). Operative mortality was higher in group I (19.8%) as compared to group II (12.8%) and group III (9.5%). Higher mortality was found to be related to a coronary artery score above 8.9, presence of left main coronary lesion, posterior or inferior location of the LVA, severe concomitant mitral valve insufficiency and incomplete revascularization of the remaining ventricular myocardium after LVA resection. Lower mortality and improved long-term results found in groups II and III as compared to group I appear to justify our choice of a "complete operation" in patients with LVA.