Elective operations for left ventricular asynergy

Abstract

Gerbode, F., Kerth, W. J., Hill, J. D., Banerjee, S., and Marcelletti, C. (1974).Thorax, 29, 282-286. Elective operations for left ventricular asynergy. Operative results in 45 patients with symptomatic left ventricular asynergy are reviewed. The main symptoms were congestive heart failure in 77·7%, angina in 31·1%, arrhythmias in 11·1%, and systemic thromboembolism in 2·2% of the patients. All patients had left heart catheterization, 40 had left ventricular angiography, and 27 had selective coronary arteriography. The last myocardial infarction occurred within three months preoperatively in 15 patients and more than 13 months prior to surgery in 27 patients. The cardiac index was 1·5 1/m2/min or less in six patients and the left ventricular end diastolic (LVED) pressure was 25 mmHg or higher in 15 patients. All patients were operated upon electively with the use of cardiopulmonary bypass. Excision of the left ventricular aneurysm was performed in 39 cases and plication in six. The immediate survival rate was 66·6%. The lowest mortality rate was among patients with angina (12·5%) and the highest in those with association of congestive heart failure and angina (66·6%). The mortality rates among patients with recent or old myocardial infarction were 46·6 and 22·2% respectively. One of the six patients with a cardiac index of 1·5 1/m2/min or less and seven of the 15 patients with LVED pressure of 25 mmHg or higher were discharged from hospital. It is concluded that ventricular aneurysmectomy has to be considered an elective procedure in order to obtain predictable results and that ideal indications for operation are angina or congestive heart failure refractory to medical treatment, associated with acceptable haemodynamics, a cardiac index of 2·0 1/m2/min or higher, and a LVED pressure below 25 mmHg.