Clinical Research On Surgical Treatment Of Left Ventricular Aneurysm

Left ventricular aneurysm is reduction or abnormal movement of left ventricularmovement. Left ventricular aneurysm is czused by large area transmural acute myocardialischemia.The survival rate for patients with Left ventricular aneurysm was10%-38%.Surgical treatment is the most effective method for treatment of left ventricular aneurysm.Objectives:To explore the results of surgical treatment for left ventricular aneurysm. Clinical datawas anylasised and expearence of surgical treatment of left ventricular aneurysm wassummarized.Methods:From2005to2011,167patients with coronary heart disease associated with leftventricula aneurysm were performed surgical treatment in An Zhen Hospital and He BeiUniversity hospital, respectively. The patients were devided into on-pump group (n=93) andoff-pump group (n=74). Detailed clinical information was collected, including gender, age,weight, diabetes, hypertension and clinical symptoms. Echocardiography examination dataincluding LVEF、FS、LVEDD、LVESD was collected preoperatively and postoperatively.Duration of ICU stay, ventilating time, amount of transfusion and perioperative complicationswas also collected. Data of the last follow-up was collected including follow-up time,classification of cardiac function, clinical symptoms and the echocardiography data. TheSPSS16.0statistical sofware was used for statistical analysis. The measurement data isexpressed as mean±standard deviation. T test and chi-square test were used to compare thedifference between groups, and P <0.05was regarded as significant.Results:1. About89.22%of the left ventricular aneurysms occurred at the anterior wall of leftventricular or at the apex,6.58%occurred at the posterior wall, and4.19%occurred at theinferior wall. In On-pump group, left ventricular aneurysms were observed at the anterior wallor the apex in75cases (44.9%). While in the Off-pump group, all the aneurysms were at theanterior wall or the apex. Thrombosis was observed in41cases (24.5%) of all the167aneurysms, which was all treated with On-pump surgery. The aneurysm size in Off-pump wassmaller than that in On-pump group. The difference was statistically significant (P <0.05). 2. The volume of plasma transfusion was656.38±452.8ml and1366.0±1338.32ml inOff-pump group and On-pump, respectively. The volume of red blood cell transfusion was4.16±3.18u and11.90±11.84u in Off-pump group and On-pump, respectively. Theventilating time was17.71±8.55h and30.18±31.83h in Off-pump group and On-pump,respectively. The duration of ICU stay was1.65±2.10d and3.28±5.39d in Off-pump groupand On-pump, respectively. IABP was used in2cases in Off-pump group and12cases inOn-pump group.The number of coronary artery bypass grafting was1.9±1.2and2.4±1.0inOff-pump group and On-pump, respectively. The difference between timepoints wasstatistically significant (P <0.05).3. In the Off-pump, the LVEF and FS at the last follow up were higher than those atpostoperative and preoperative. The difference between timepoints was statisticallysignificant (P <0.05). The LVEDD and LVESD at the last follow up were smaller than thoseat postoperative and preoperative. The difference between timepoints was statisticallysignificant (P<0.05). The classification of cardiac function at the last follow up wassignifcantly higher than that at preoperative (P <0.05).4. In the On-pump, the LVEF and FS at the last follow up were higher than those atpostoperative and preoperative. The difference between timepoints was statisticallysignificant (P <0.01). The LVEDD and LVESD at the last follow up were smaller than thoseat postoperative and preoperative. The difference between timepoints was statisticallysignificant (P<0.05). The classification of cardiac function at the last follow up wassignifcantly higher than that at preoperative (P <0.05).5. Among all the167cases, some perioperative complications were observed includingperioperative death in11cases, pulmonary infection in4cases, low cardiac output in2cases,malignant ventricular arrhythmias in2cases. Among the11perioperative death cases,2caseswere in the Off-pump group (mortality rate2.7%), and the other9cases were in the On-pumpgroup (mortality rate9.6%).6. In the Off-pump group, perioperative complications were observed in12cases (12.6%),including perioperative arrhythmia in10cases, pulmonary infection in1case, and renalfailure in1case. While in On-pump, perioperative complications were observed in17cases(18.27%), including perioperative arrhythmias in7cases, pulmonary infection in4cases,multiple organ failure in3cases, and reoperation for hemostasis in3cases. Conclusions:1. Left ventricle reconstruction and CABG can both restore the volume of left ventricleand improve myocardial function.It’s an effective and security surgical method for patientswith coronary heart disease associated with left ventricular aneurysm.2. The surgical method of left ventricular aneurysm is suitable for patients without muralthrombus,better heart function,a smaller aneurysm patients.It can reduce complications ofcardiopulmonary bypass,rapid postoperative recovery.3. On-pump is suitabl for For patients who can not tolerate off-pump and have muralthrombus and big aneurysm.4. IABP is an effective method of CABG and left ventricular aneurysm especially forpatients with bid aneurysm and poor heart function.