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ORIGINAL ARTICLE

Left ventricular aneurysmectomy with geometric reconstruction: surgical aspects and immediate results

Gilmar Geraldo dos SantosI; Victor L. S HaddadI; Silas F Avelar Jr; Antônio Amauri Groppo; Ricardo BeyrutiI; Rosa Maria SimõesI; Noedir A. G StolfI

DOI: 10.1590/S0102-76381991000200007

ABSTRACT

The early results of 79 patients who underwent left ventricular aneurysmectomy with the geometric and circular reconstruction in a seven years experience are analyzed. The most common indication for operation was congestive heart failure (78.4%), isolated (25.3%) or with coronary artery disease (53.1%). Sixty (76%) patients were in NYHA class III and 10 (12.6%) in NYHA class IV at the time of surgery. Fifty eight (73.4%) underwent coronary artery bypass graft surgery. Hospital mortality was 5.1% and patients older than 60 (12%), in NYHA class IV (20%), with poor left ventricular function (FE < 0.30 - 20% and LVEDP > 25 - 14%) and extensive coronary artery disease (10%) were under increased risk. Low cardiac output and use of IABP were also associate with this risk factors. Other factors of increased risk pointed in the literature are discussed. There were no deaths for isolated left ventricular aneurysmectomy. The early results of this study and the early and late results from others using the same technique are better than that obtained by others with different types of correction and they suggest that this is the procedure of choice to treat left ventricular aneurysm.

RESUMO

Os resultados imediatos de 79 pacientes operados num período de sete anos para tratamento cirúrgico de aneurisma de ventrículo esquerdo com a técnica de reconstrução geométrica circular são analisados. A indicação cirúrgica mais freqüente foi a insuficiência cardíaca congestiva (78,4%), isolada (25,3%) ou associada à insuficiência coronária (53,1%). Sessenta (76%) pacientes estavam em classe funcional III e 10 (12,6%) em classe funcional IV. Cinqüenta e oito (73,4%) pacientes foram submetidos à revascularização do miocárdio concomitantemente. A mortalidade hospitalar foi de 5,1% e teve incidência maior nos pacientes com idade acima de 60 (12%) anos, em classe funcional IV (20%), com má função ventricular (FE < 0,30 - 20% e PDfVE > 25 - 14%) e lesões coronárias triarteriais (10%). Estes fatores também estiveram associados a complicações cardíacas com baixo débito e uso de BIA. Outros fatores de risco citados na literatura são discutidos. Os resultados imediatos desse estudo e os resultados imediatos e tardios de outros em que a técnica usada foi semelhante são melhores que os obtidos com outros tipos de correção e sugerem ser este o procedimento de escolha para o tratamento dessa afecção.
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Article receive on Thursday, May 2, 1991

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