Experience of post-infarction left ventricular aneurysm reconstruction with on-pump beating heart technique

Abstract

Aim. To evaluate the results of surgical treatment of post-infarction left ventricular aneurysms with on-pump beating heart technique.

Methods. In our center from April, 2009 to January, 2014 169 patients had reconstruction of the left ventricle with on-pump beating heart technique. Among the patients 159 were males (94.1%) and 10 of them were females (5.9%), average age 53.8±8.9 years (39 to 72 years). Angina pectoris class I (according to the classification of Canadian Heart Association) was established in 7 (4.1%) patients, class II - in 49 (29.0%), class III - in 107 (63.3%), class IV - in 4 (2.4%), unstable angina in 2 (1.2%) patients. Chronic heart failure class I (according to New York Heart association functional classification) was diagnosed in 5 (3.0%) patients, class II in 37 (21.9%), class III in 124 (73.4%), class IV in 3 (1.8%) patients. Average ejection fraction of the left ventricle was 38.6±7.9% (25 to 67%). Mitral valve insufficiency stage 2-3 was revealed in 23 (13.6%) patients.

Results. Endoventriculoplasty of the left ventricle by Dor's technique was performed in 49 (29.0%) patients, auto-septoplasty of the left ventricle - 59 (34.9%) patients, linear repair in 40 (23.7%) patients. Combined surgical interventions were performed in 21 (12.4%) patients. In-hospital lethality was 2.4% (n=4).

Conclusion. Left ventricular reconstruction with on-pump beating heart technique without cardioplegic arest is effective and safe; the method allows performing remodelling of the left ventricle and reaching the target volume parameters.

Keywords

post-infarction aneurysm / left ventricular repair / beating heart

References

[1] Bockeria L.A., Gudkova R.G. Serdechno-sosudistaya khirurgiya — 2014. Bolezni i vrozhdennye anomalii sistemy krovoobrashcheniya. (Cardiovascular surgery — 2014. Diseases and congenital anomalies of the circulatory system.) Moscow: Izdatel'stvo nauchnogo tsentra serdechno-sosudistoy khirurgii imeni A.N. Bakuleva. 2015; 228 p. (In Russ.)

[2] Бокерия Л.А., Гудкова Р.Г. Сердечно-сосудистая хирургия — 2014. Болезни и врождённые аномалии системы кровообращения. М.: изд-во НЦССХ им. А.Н. Бакулева. 2015; 228 с.

[3] Alshibaya M.M., Vishchipanov S.A., Vishchipanov A.S., Nikiforova M.A. Surgical treatment of young patients with post-infarction heart aneurysm. Grudnaya i serdechno-­sosudistaya khirurgiya. 2014; (2): 41–43. (In Russ.)

[4] Алшибая М.М., Вищипанов С.А., Вищипанов А.С., Никифорова М.А. Хирургическое лечение молодых больных с постинфарктной аневризмой сердца. Грудн. и сердеч.-сосуд. хир. 2014; (2): 41–43.

[5] Epub ahead of print.

[6] Doulamis I.P., Perrea D.N., Chloroyiannis I.A. Left ventricular reconstruction surgery in ischemic heart di­sease: a systematic review of the past two decades. J. Cardiovasc. Surg. (Torino). 2018 Nov. 20. DOI: 10.23736/S0021-9509.18.10647-1.

[7] Chon L.H. Cardiac surgery in the adult. Third edition. New York: Mc Graw-Hill Professional. 2007; 1584 p.

[8] Isomura T., Taiko H., Hisayoshi S., Buckberg G. Septal anterior ventricular exclusion operation (Pacopexy) for ischemic dilated cardiomyopathy: treat form not di­sease. Eur. J. Cardiothorac. Surg. 2006; 29: 245–250. DOI: 10.1016/j.ejcts.2006.03.008.

[9] Menicanti L., Di Donato M. Surgical left ventricle reconstruction, pathophysiologic insights, results and expectation from the STICH trial. Eur. J. Cardiothorac. Surg. 2004; 26: S42–S47. DOI: 10.1016/j.ejctsup.2004.11.012.

[10] Mickleborough L.L., Merchant N., Ivanov J. et al. Left ventricular reconstruction: Early and late results. J. Thorac. Cardiovasc. Surg. 2004; 128 (1): 27–37. DOI: 10.1016/j.jtcvs.2003.08.013.

[11] Matsui Y., Fukada Y., Naito Y., Sasaki S. Integra­ted overlapping ventriculoplasty combined with papillary ­muscle plication for severely dilated heart failure. J. Thorac. Cardiovasc. Surg. 2004; 127 (4): 1221–1223. DOI: 10.1016/j.jtcvs.2003.10.044.

RIGHTS & PERMISSIONS

Tarasov D.G., Chernov I.I., Molochkov A.V., Pavlov A.V.