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Jai Raman, Anand Dixit, Meg Storer, David Hare.
Department of Cardiac Surgery, Austin & Repatriation Medical
Centre, Heidelberg, Vic.
Introduction: Surgical reconstruction of inferior left
ventricular (LV) aneurysms and scars have been considered difficult
and are associated with a poor outcome. We report on our experience
with reconstruction of the inferior wall and compare it to the
outcome with anterior LV reconstructions.
Methods: Seventeen patients underwent Geometric Endo-ventricular
patch repair (GER) of inferior LV aneurysms and scars between
Jan, 1998 and Sep, 2000 (Group 1). Five of these patients had
severe MR, 8 had mod. MR and 4 had mild MR in addition to poor
LV function (mean Ejection Fraction of 28 %), pre-operatively.
These patients underwent coronary artery bypass graft surgery
and/or valve surgery in addition. The peri-operative course,
survival and clinical status was evaluated in this group was compared
to 75 patients undergoing anterior GER during the same period
(Group 2).
Results: There was 1 early death in Group 1 (5.8 %),
and 5 in Group 2 (6.6 %), p=ns. At the conclusion of the operative
procedure, all patients in Group 1 were weaned off cardiopulmonary
bypass with trivial to mild MR. There was one late death in Group
1 (6.2 %) and 2 in Group 2 (2.8%), p=ns. 12 patients (75 %) in
Group 1 were in NYHA Class 1, compared to 52 in Group 2 (73 %)
(p=ns). Follow-up echocardiography showed that 75 % in Group
1 had trivial MR.
Conclusion: Surgical reconstruction of inferior LV aneurysms
and scars can be performed safely with the expectation of a reasonable
long-term outcome similar to that achieved with anterior LV scars.
GER in this setting improves MR, reducing the likelihood of heart
failure decompensation.
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