Clinical Outcomes of Plication of Left Ventricular Aneurysm During Off-pump Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Wei , ZHANG Jianqun , KONG Qingyu , CHI Liqun , CHEN Xinliang .

Department of Cardiovascular Surgery， Beijing Anzhen Hospital， Capital Medical University， Beijing 100029， P. R. China;

Corresponding author：

Keywords：

Left ventricular aneurysm; Plication of ventricular aneurysm; Off-pump beating-heart; Coronary artery bypass grafting

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　　Abstract： Objective To evaluate clinical outcomes of plication of left ventricular aneurysm during off-pump coronary artery bypass grafting （OPCAB）. Methods A total of 114 patients who underwent coronary artery bypass grafting （CABG） and concomitant surgical treatment for left ventricular aneurysm from January 2007 to January 2011 in Beijing Anzhen Hospital were included in this study. All the patients were divided into 2 groups according to the different surgical procedures they received. In groupⅠ， there were 76 patients including 57 males and 19 females with their average age of （63.4±7.8） years who underwent CABG and left ventricular aneurysmectomy under cardiopulmonary bypass on the　 non-beating heart. In groupⅡ， there were 38 patients including 32 males and 6 females with their average age of （60.6±8.9） years who underwent OPCAB and plication of the left ventricular aneurysm on the beating heart. Preoperative data were not statistically different between the 2 groups except that the percentage of the left ventricular aneurysm to the left ventricle　 of groupⅠwas significantly larger than that of groupⅡ（42.2%±13.6% vs. 26.5%±12.3％， t=5.499， P=0.000）. Postoperative clinical outcomes and morbidities were compared between the 2 groups， and all the patients were followed up for 6 months. Results There was 2 in-hospital death in groupⅠ， one for postoperative refractory ventricular arrhythmia， and the other for severe pneumonia. There was 1 in-hospital death in groupⅡ because of perioperative myocardial infarction. Postoperative thoracic drainage， incidence of reexploration for bleeding， mechanical ventilation time and incidence of　 intra-aortic balloon pump （IABP） implantation were not statistically different between the 2 groups （P＞0.05）. To compare　 their echocardiography outcomes at early postoperative stage and 6 months after discharge with preoperative values， left ventricular end-diastolic dimensions （LVEDD） at early postoperative stage and 6 months after discharge were both signific antly decreased than preoperative value in both groups ［groupⅠ：（54.0±7.8） mm amp; （56.0±8.1） mm vs. （59.6±6.6） mm，　 groupⅡ：（52.0±7.2） mm amp; （53.6±5.3） mm vs. （57.9±5.4） mm］， and left ventricular ejection fraction （LVEF） at early　 postoperative stage and 6 months after discharge were both significantly higher than preoperative value in both groups　（groupⅠ：43.5%±3.2％ amp; 55.7%±3.7% vs. 38.0%±7.4%， groupⅡ：44.7%±2.8％ amp; 57.0%±3.5% vs. 41.0%±6.6%）， but there was no statistical difference in LVEDD and LVEF between the 2 groups（P＞0.05）. Conclusion Plication of　 left ventricular aneurysm during OPCAB is a safe and effective surgical procedure， and possibly more appropriate for patients　 with a smaller left ventricular aneurysm.

Citation： XIAO Wei,ZHANG Jianqun,KONG Qingyu,CHI Liqun,CHEN Xinliang .. Clinical Outcomes of Plication of Left Ventricular Aneurysm During Off-pump Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 20-23. doi: Copy

1.	3 Jatene AD . Left ventricular aneurysmectomy. Resection or reconstruction. J Thorac Cardiovasc Surg， 1985， 89 （3）：321-331.
2.	4 Dor V ， Saab M ， Coste P ， et al. Left ventricular aneurysm：a new surgical approach. Thorac Cardiovasc Surg ， 1989， 37 （1）：11-19.
3.	13 Lundblad R， Abdelnoor M， Svennevig JL. Surgery for left ventricular　 aneurysm：early and late survival after simple linear repair and endoventricular patch plasty. J Thorac Cardiovasc Surg， 2004， 128 （3）：449-456.
4.	Faxon DP， Ryan TJ， Davis KB， et al. Prognostic significance of angiographically documented left ventricular aneurysm from the Coronary Artery Surgery Study （CASS）. Am J Cardiol， 1982， 50 （1）：157-164.
5.	Cooley DA， Collins HA， Morris GC Jr， et al. Ventricular aneurysm after myocardial infarction；surgical excision with use of temporary cardiopulmonary bypass. J Am Med Assoc， 1958， 167 （5）：557-560.
6.	Castiglioni A， Quarti A， Schreuder J， et al. Surgical restoration of the left ventricle for postinfarction aneurysm. Ital Heart J， 2002， 3 （6）：370-374.
7.	Doss M， Martens S， Sayour S， et al. Long term follow up of left ventricular function after repair of left ventricular aneurysm. A comparison of linear closure versus patch plasty. Eur J Cardiothorac Surg，2001， 20 （4）：783-785.
8.	Praeger PI， Praeger JA， Lee LY. Off-pump plication of left ventricular aneurysm. Ann Thorac Surg， 2011， 92 （4）：1514-1516.
9.	李浩杰，宋云虎，胡盛寿，等. 实时三维超声评价左室室壁瘤外科治疗后左心室局部收缩功能的改变. 中国胸心血管外科临床杂志， 2011， 18 （3）：209-213.
10.	董然，陈宝田，刘韬帅，等. 非体外及体外循环下左心室运动异常型室壁瘤切除术的临床疗效比较. 中国胸心血管外科临床杂志， 2009， 16 （6）：421-425.
11.	徐明，陈绪军，陈鑫，等. 巨大左心室而无室壁瘤冠心病患者行冠状动脉旁路移植术的疗效分析. 中国胸心血管外科临床杂志， 2011， 18 （2）：117-120.
12.	王联群，徐栋，孟冬梅，等. 冠状动脉搭桥术同期行左心室室壁瘤切除术的疗效分析. 中国循环杂志， 2009， 24 （6）：465-467.
13.	Huang XS， Gu CX， Yang JF， et al. Off-pump anteroapical aneurysm plication for left ventricular post-infarction aneurysm：long-term results. Chin Med J （Engl）， 2012， 125 （18）：3228-3235.
14.	Monaco M， Stassano P， Di Tommaso L， et al. Surgery for left ventricular aneurysm：is there still any role for simple linear repair ? J Card Surg， 2009， 24 （2）：156-161.

1. 3 Jatene AD . Left ventricular aneurysmectomy. Resection or reconstruction. J Thorac Cardiovasc Surg， 1985， 89 （3）：321-331.
2. 4 Dor V ， Saab M ， Coste P ， et al. Left ventricular aneurysm：a new surgical approach. Thorac Cardiovasc Surg ， 1989， 37 （1）：11-19.
3. 13 Lundblad R， Abdelnoor M， Svennevig JL. Surgery for left ventricular　 aneurysm：early and late survival after simple linear repair and endoventricular patch plasty. J Thorac Cardiovasc Surg， 2004， 128 （3）：449-456.
4. Faxon DP， Ryan TJ， Davis KB， et al. Prognostic significance of angiographically documented left ventricular aneurysm from the Coronary Artery Surgery Study （CASS）. Am J Cardiol， 1982， 50 （1）：157-164.
5. Cooley DA， Collins HA， Morris GC Jr， et al. Ventricular aneurysm after myocardial infarction；surgical excision with use of temporary cardiopulmonary bypass. J Am Med Assoc， 1958， 167 （5）：557-560.
6. Castiglioni A， Quarti A， Schreuder J， et al. Surgical restoration of the left ventricle for postinfarction aneurysm. Ital Heart J， 2002， 3 （6）：370-374.
7. Doss M， Martens S， Sayour S， et al. Long term follow up of left ventricular function after repair of left ventricular aneurysm. A comparison of linear closure versus patch plasty. Eur J Cardiothorac Surg，2001， 20 （4）：783-785.
8. Praeger PI， Praeger JA， Lee LY. Off-pump plication of left ventricular aneurysm. Ann Thorac Surg， 2011， 92 （4）：1514-1516.
9. 李浩杰，宋云虎，胡盛寿，等. 实时三维超声评价左室室壁瘤外科治疗后左心室局部收缩功能的改变. 中国胸心血管外科临床杂志， 2011， 18 （3）：209-213.
10. 董然，陈宝田，刘韬帅，等. 非体外及体外循环下左心室运动异常型室壁瘤切除术的临床疗效比较. 中国胸心血管外科临床杂志， 2009， 16 （6）：421-425.
11. 徐明，陈绪军，陈鑫，等. 巨大左心室而无室壁瘤冠心病患者行冠状动脉旁路移植术的疗效分析. 中国胸心血管外科临床杂志， 2011， 18 （2）：117-120.
12. 王联群，徐栋，孟冬梅，等. 冠状动脉搭桥术同期行左心室室壁瘤切除术的疗效分析. 中国循环杂志， 2009， 24 （6）：465-467.
13. Huang XS， Gu CX， Yang JF， et al. Off-pump anteroapical aneurysm plication for left ventricular post-infarction aneurysm：long-term results. Chin Med J （Engl）， 2012， 125 （18）：3228-3235.
14. Monaco M， Stassano P， Di Tommaso L， et al. Surgery for left ventricular aneurysm：is there still any role for simple linear repair ? J Card Surg， 2009， 24 （2）：156-161.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcomes of Plication of Left Ventricular Aneurysm During Off-pump Coronary Artery Bypass Grafting

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