Ventricular aneurysms and akinesis

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With the advent of cardiopulmonary bypass, excision of postinfarction ventricular aneurysms became one of the first acquired cardiac lesions to be treated surgically with success. The earlier results reported by Bailey and associates of ventricular resection by the closed technique and with the beating heart were truly remarkable, but by present standards would not be acceptable. In 1958 we reported our initial results with the open technique and pointed out the advantages of a more anatomic repair preserving and restoring left ventricular function and the careful removal of contained thrombus. The technique of aneurysmal excision remained essentially the same until 10 years later when development of selective coronary arteriography led to direct myocardial revascularization by the vein procedure. Thus, we have divided our experience with ventricular aneurysms into two groups, i.e., before and after the bypass became available, and the year 1969 was selected as the dividing point (Table). Before 1969, 100 patients underwent aneurysmal resection without cardiopulmonary bypass and 19 died within 30 days (19%). Since 1969, 684 patients underwent operation with 61 deaths (8.9% mortality). The mortality was actually higher in the revascularized patients (Table). The results between the two periods reveal an improvement in surgical mortality, and we believe the survivors have a better prognosis in terms of both symptomatic relief (angina) and a better chance for subsequent cardiac functional recovery. During the period since 1969 the slightly increased mortality among the revascularized patients reflects in part the greater severity and extent of their coronary vascular disease . . .



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