Abstract:
For safe resection, left ventricular aneurysmal repair after acute myocardial infarction is
usually delayed. However, delaying surgery may not be possible or prudent in some patients
who are clinically unstable after acute myocardial infarction.
We retrospectively reviewed the early and mid-term outcomes of left ventricular aneurysmal
repair in patients who had experienced acute myocardial infarction <30 days before
the repair. From September 2001 through May 2006, 127 consecutive post-infarction
patients underwent concurrent anteroapical left ventricular aneurysmal repair and coronary
artery bypass grafting. In Group I (38 clinically unstable patients), the surgery was
performed <30 days after myocardial infarction. In Group II, 89 patients underwent the
surgery ≥30 days after infarction. The mean follow-up period was 26.16 ± 16.41 months.
One Group I patient (2.6%) died in the hospital due to graft-versus-host reaction. Three
Group II patients (3.4%) died: 2 of low cardiac output and 1 of multiple-organ failure. Hospital
mortality rates were not statistically significant between groups (P=0.582). All patients
required similar perioperative inotropic support, intra-aortic balloon pump support, and reexploration
for bleeding or cardiac tamponade. The actuarial survival rates were 94.7%
(Group I) and 94.4% (Group II). Postoperative New York Heart Association functional class
improved similarly in both groups.
We infer that left ventricular aneurysmal repair with coronary revascularization <30 days
after a recent myocardial infarction is a feasible procedure, with acceptable morbidity and
mortality rates. Our mid-term results were comparable with those for patients who underwent
this surgery ≥30 days after acute myocardial infarction. (Tex Heart Inst J 2007;34:
154-9)
