Clinical Study On Surgical Treatment Of Ventricular Aneurysm Combined With Ventricular Thrombu

Objectives The study aimed to identify risk factors of preoperative ventricular thrombus in patients with ventricular aneurysm,so as to assist surgeons in identifying high-risk patients who might have ventricular thrombus before surgery.Meanwhile,the study aimed to analyze the perioperative results of ventricular aneurysm with ventricular thrombus and explore the impact of preoperative ventricular thrombus on the perioperative results of ventricular aneurysm surgery.Methods The clinical data of consecutive patients with ischemic ventricular aneurysm undergoing surgery at our center from January 2010 to April 2021 were retrospectively analyzed.The patients were divided into group ventricular thrombus and group control according to whether ventricular thrombus was present.Univariate and multivariate logistic regression analysis were applied to figure out possible risk factors of preoperative ventricular thrombus in ventricular aneurysm patients undergoing surgical therapy.While analyzing the impact of preoperative ventricular thrombus on the perioperative results of ventricular aneurysm surgery,the primary study endpoint was perioperative composite adverse events consisting of re-exploration,perioperative myocardial infarction,perioperative stroke,perioperative hemofiltration,perioperative intra-aortic balloon pump,perioperative ventricular assist device implantation,perioperative extracorporeal membrane oxygenation,and in-hospital death.Secondary endpoints included perioperative blood transfusion,mechanical ventilation time≥24 hours,intensive care unit(ICU)stay≥72 hours,and perioperative acute renal injury.The impact of preoperative ventricular thrombus on perioperative outcomes of ventricular aneurysm surgery was further assessed after adjustment of potential confounders via multivariate logistic regression analysis.Results A total of 920 patients were included in the analysis.Patients with ventricular thrombus were younger than those without ventricular thrombus(56.6±10.5y vs.59.1±9.4y,P=0.001).Multivariate analysis showed that the history of percutaneous coronary intervention(PCI)(OR=1.726;95%CI,1.197-2.475;P=0.003)and ventricular aneurysm diameter≥40mm(OR=1.547;95%CI,1.119-2.136;P=0.008)were risk factors of preoperative ventricular thrombus in ventricular aneurysm patients,while older age(OR=0.979;95%CI,0.962-0.996;P=0.015),triple vessel lesions(OR=0.692;95%CI,0.501-0.955;P=0.025),mitral regurgitation(OR=0.694;95%CI,0.494-0.970;P=0.034)and ventricular septal rupture(OR=0.380;95%CI,0.162-0.785;P=0.015)were protective factors of preoperative ventricular thrombus in ventricular aneurysm patients.In the analysis of the impact of preoperative ventricular thrombus on the perioperative results of ventricular aneurysm surgery,multivariate analysis showed that ventricular thrombus could increase the risk of perioperative composite adverse events of ventricular aneurysm surgery(OR 1.848,95%CI 1.024-3.268,P=0.037),while ventricular thrombus had no impact on the secondary study endpoints of perioperative blood transfusion,mechanical ventilation time≥24 hours,ICU stay≥72 hours,or acute renal injury.Conclusions Patients with younger age,ventricular aneurysm diameter≥40mm and history of PCI were more likely to have ventricular thrombus before ventricular aneurysm surgery,while those with triple vessel lesions,mitral regurgitation and ventricular septal rupture were less likely to have preoperative ventricular thrombus.Preoperative ventricular thrombus could increase the risk of perioperative composite adverse events in ventricular aneurysm surgery.Objectives The study aimed to analyze the long-term results of surgical treatment of ventricular aneurysm with ventricular thrombus,and the impact of ventricular thrombus on the long-term results of ventricular aneurysm surgery.Methods The clinical data of patients with ischemic ventricular aneurysm undergoing surgery at our center from January 2010 to April 2021 were retrospectively analyzed.The exclusion criteria included ventricular septal rupture,valvular surgery,and in-hospital death.The patients were divided into group ventricular thrombus and group control according to whether ventricular thrombus was present.The primary endpoints were allcause mortality and the main adverse cardiac and cerebrovascular events(MACCEs).MACCEs was the composite endpoint consisting of all-cause mortality,nonfatal myocardial infarction,stroke and revascularization.The secondary endpoints were nonfatal myocardial infarction,stroke,and revascularization.Kaplan-Meier method was utilized to compare the primary and secondary endpoints between groups.The impact of ventricular thrombus on the long-term prognosis of ventricular aneurysm surgery was further assessed after adjustment of potential confounders via Cox proportional hazards model.Results After excluding concurrent other surgeries and in-hospital death based on the population in the first part,a total of 727 patients were included in the study.During the median follow-up of 61 months(interquartile range:38.5-96.5 months),there was no significant difference between the two groups in the risk of all-cause mortality(P=0.38)and MACCEs(P=0.99).Patients with ventricular thrombus had significantly higher risk of nonfatal myocardial infarction(P=0.047)and revascularization therapy(P=0.0018)than those in the group control.No significant difference was observed in the risk of stroke between the two groups(P=0.076).After adjusting for possible confounding factors,ventricular thrombus could increase the risk of nonfatal myocardial infarction(HR=2.448;95%CI,1.105-5.422;P=0.027)and revascularization(HR=4.065;95%CI,1.822-9.068;P<0.001),but did not affect the risk of MACCCEs(P=0.396),all-cause mortality(P=0.873)and stroke(P=0.129)after ventricular aneurysm surgery.Conclusions Preoperative ventricular thrombus could significantly increase the risk of nonfatal myocardial infarction and revascularization after ventricular aneurysm surgery.Objectives The study aimed to investigate the role of prophylactic anticoagulation with warfarin for 3-6 months in ventricular thrombus recurrence and other clinical outcomes after ventricular aneurysm surgery and ventricular thrombectomy.Methods All consecutive patients undergoing ventricular aneurysm surgery together with ventricular thrombectomy at our center between 2010.1.1 and 2021.4.1 were included in the study.Individuals included were divided into group warfarin and group control based on whether warfarin was administered at discharge.Patients in group warfarin received anticoagulation with warfarin for 3-6 months with target INR of 2-3.Patients with warfarin were matched to their counterparts without warfarin based on the baseline characteristics via propensity score matching(PSM)at the ratio of 1:1.The primary endpoint was ventricular thrombus recurrence.Ventricular thrombus recurrence could be screened by transthoracic echocardiography and further assessed by cardiac computed tomography or magnetic resonance.The time when recurred ventricular thrombus was detected by imaging follow-up was defined as the time of ventricular thrombus recurrence.The secondary endpoints were major adverse cardiac and cerebrovascular events(MACCEs)and the composite endpoint of ventricular thrombus recurrence and MACCEs.Results Before PSM,patients in group warfarin were younger(median,53.0y(IQR,45.560,0y)vs.59.0y(IQR,51.0-63.5y),P=0.017)and had a higher rate of smoking history(78.0%vs.62.2,P=0.050).After PSM,a total of 1 18 patients were included in the study,among whom 59 received warfarin therapy at discharge and 59 didn’t.During the median follow-up of 56.5 months(IQR:32-89 months),21 out of 118 patients had ventricular thrombus recurrence and the recurrence rate was 1 7.8%.There was no systemic embolism resulting from the recurrent ventricular thrombus.Kaplan-Meir analysis showed no significant difference in ventricular thrombus recurrence(P=0.86),MACCEs(P=0.48)and the composite endpoint of ventricular thrombus recurrence and MACCEs(P=0.89)between the two groups.Cox proportional hazards regression model showed that history of PCI(HR 2.778,95%CI 1.087-7.100,P=0.033)and ventricular aneurysm surgical strategy of linear suture(HR 8.769,95%CI 1.139-67.5 1 7,P=0.037)were independent risk factors of ventricular thrombus recurrence.Conclusions Prophylactic anticoagulation with warfarin for 3-6 months may be unnecessary with no significant benefit in terms of ventricular thrombus recurrence and other clinical outcomes.The history of PCI and ventricular aneurysm surgical strategy of linear suture may increase the risk of ventricular thrombus recurrence after surgery.Objectives The study aimed to compare the efficacy and safety of new oral anticoagulants(NO AC)and warfarin in the treatment of ventricular thrombus.Methods Through a systematic search for studies in Pubmed,Embase,Cochrane Library and CNKI comparing NOAC and warfarin in the treatment of ventricular thrombus before January 2023,a meta-analysis of the relevant studies was conducted.The primary effectiveness endpoint was the ventricular thrombus resolution rate after 3 months,6 months and 1 year of anticoagulation,as well as stroke and systemic embolism events during anticoagulation.The primary safety endpoint was bleeding events of any degree.When there was high heterogeneity among studies(I2>50%),the random effect model was adopted.Otherwise,the fixed effect model was adopted.Results A total of 21 studies were included in the final analysis,including 3655 patients(1162 patients in the group NOAC and 2493 patients in the group warfarin).The metaanalysis showed that compared with group warfarin,the ventricular thrombus resolution rate was higher in the group NOAC at 3 months(OR 1.60,95%CI:1.11-2.29,P=0.01),6 months(OR 2.10,95%CI:1.47-3.01,P<0.0001),and 1 year(OR 1.62,95%CI:1.16-2.27,P=0.005)of anticoagulation.The incidence of stroke(OR 0.71,95%CI:0.51-1.00,P=0.05)and systemic embolism events(OR 0.51,95%CI:0.29-0.90,P=0.02)was lower in the group NOAC.The incidence of bleeding events was also lower in the group NOAC(OR 0.64,95%CI:0.50-0.83,P=0.0006).Conclusions NOAC may be superior to warfarin in terms of efficacy and safety in the treatment of ventricular thrombus.However,high-quality randomized controlled trials are still warranted to verify the findings in the future.