Factors affecting late survival after surgical remodeling of left ventricular aneurysms Hooshang Bolooki, MD, Eduardo DeMarchena, MD, Stephen M Mallon,

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Presentation transcript:

Factors affecting late survival after surgical remodeling of left ventricular aneurysms Hooshang Bolooki, MD, Eduardo DeMarchena, MD, Stephen M Mallon, MD, Kushagra Katariya, MD, Michael Barron, MD, H.Michael Bolooki, BS, Richard J Thurer, MD, Stana Novak, Robert C Duncan, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 126, Issue 2, Pages 374-383 (August 2003) DOI: 10.1016/S0022-5223(03)00023-0

Figure 1 Surgeon’s view of the anterior wall of the heart after LV volume restoration operation with an oval endoventricular Dacron patch. The black arrowheads point to the sutures that secure the patch and the purse-string suture. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 374-383DOI: (10.1016/S0022-5223(03)00023-0)

Figure 2 Intraoperative transesophageal echocardiogram. The views are in systole (A, C) and diastole (B, D) before (A, B) and after (C, D) volume reduction surgery in a patient in group III. Left atrium (LA), left ventricle (LV), mitral valve (MV), aneurysm (A), and right ventricle (RV) are identified. The arrowheads show the extent of the anterior endoventricular patch in systole (C) and diastole (D). Note the extent of LV volume reduction and apical restoration. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 374-383DOI: (10.1016/S0022-5223(03)00023-0)

Figure 3 Actuarial survival for all patients at risk including (A) and excluding (B) early (operative) mortality. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 374-383DOI: (10.1016/S0022-5223(03)00023-0)

Figure 4 Comparison of actuarial survival in the 3 patient groups after LV volume reduction surgery: group I, radical resection; group II, septoplasty; group III, endoventricular patch. P = .2290. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 374-383DOI: (10.1016/S0022-5223(03)00023-0)

Figure 5 Actuarial survival including the early mortality comparing the results for the 3 operative techniques. A, All patients at risk in groups I and III are compared. P = .1591. B, All patients at risk in groups II and III are compared. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 374-383DOI: (10.1016/S0022-5223(03)00023-0)

Figure 6 Actuarial late survival excluding early death according to preoperative variables: ejection fraction (EF), pulmonary artery occlusive (PAO) pressure, intra-aortic balloon pump (IABP), and ventricular tachyarrhythmia (VT). D, P = .3356; E, P = .2427; F, P = 3184. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 374-383DOI: (10.1016/S0022-5223(03)00023-0)

Figure 7 Heart specimen showing mid-ventricular section 6 months after volume reduction surgery with septoplasty technique (group II). The septal patch (white arrowheads), right ventricle (RV), left ventricle (LV), septum (S), and patent anterior descending artery (A) are shown. This patient died suddenly of cardiac dysrhythmia probably caused by a posterior septal infarction (black arrowheads). White arrows indicate 2 implanted defibrillator patches. Note the suture line (black arrow), the thick wall LV cavity, and the septal wall with the Teflon patch. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 374-383DOI: (10.1016/S0022-5223(03)00023-0)

Figure 8 Preoperative (A, B) and postoperative (C, D) left ventriculograms in systole (A, C) and diastole (B, D) in a patient in group III. Preoperatively, the apex contained islands of clots. Note restoration of LV apex and improvement in systolic function. The Journal of Thoracic and Cardiovascular Surgery 2003 126, 374-383DOI: (10.1016/S0022-5223(03)00023-0)