High incidence of sudden death late after anterior LV-aneurysm repair.

OBJECTIVES: Sudden death due to ventricular arrhythmias occurs frequently among patients with dilated cardiomyopathy and congestive heart failure (CHF). In patients with left ventricular (LV) aneurysms, LV-aneurysm repair (LVAR) reduces LV-size and ameliorates symptoms of CHF, but the incidence of late sudden death is unknown, especially after LVAR without concomitant anti-arrhythmic therapy. METHODS: Between June 1993 and June 1999, 147 patients (70% males; 62+/-9 years) with CHF (median: NYHA III) due to anterior LV-aneurysms underwent LVAR. None of the patients underwent anti-arrhythmic surgical procedures concomitant to LVAR. Ninety percent of the patients had additional myocardial revascularization. Hospital records and laevocardiograms were reviewed, and follow-up information was obtained. RESULTS: In-hospital mortality was 4.1% (n=6). The median follow-up was 3.7 years (0.1-73.4 months; overall 462 patient-years). At follow-up, the patients had significantly less symptoms than preoperatively (median: NYHA II, P<0.001). Nineteen patients had died (5-year survival rate 78%). Of these late deaths, 84% (n=16) were cardiac-related, among which sudden death was most frequent (n=7). Predictors of sudden death were a bypass graft to the right coronary artery (P=0.0100), ventricular tachyarrhythmias early postoperatively (P=0.0315), and cross-clamp time (P=0.0496). CONCLUSIONS: Although the survival and functional state of most patients were good after LVAR without concomitant anti-arrhythmic surgery, we observed a high incidence of late sudden death, which was-among others-significantly associated with postoperative ventricular tachyarrhythmias. To further improve outcomes, intra- and postoperative anti-arrhythmic therapy is advisable in patients undergoing LVAR.

Results of endoaneurysmorrhaphy: does the location of the aneurysm matter?

Endoaneurysmorrhaphy is mostly performed on anterior-septal left ventricular (LV) aneurysms. It may also be applied to posterior aneurysms, which is technically more challenging. Whether the surgical risk is the same, irrespective of the location of the aneurysm, has not been studied before. We reviewed our experience with 158 patients (62+/-9 years, 72% male) undergoing endoaneurysmorrhaphy. Eleven patients (7%) had posterior LV aneurysms. Perioperative mortality was 5.7%. Of all preoperative and surgical variables tested, the presence of a posterior LV aneurysm (p=0.017), concomitant mitral valve surgery (p=0.008) and duration of extracorporal circulation (p=0.001) were significantly associated with higher perioperative mortality. However, patients with posterior LV aneurysms had more severe heart failure (p=0.0061) and a higher LV end diastolic volume index (138+/-38 vs. 102+/-41 ml/kg body weight; p=0.040) than patients with antero-septal LV aneurysms. Further studies are needed to determine whether the location of the aneurysm is a risk factor for mortality irrespective of the clinical presentation.