Perioperative and long-term results with mapping-guided subendocardial resection and left ventricular endoaneurysmorrhaphy

Hassan Rastegar, Mark S. Link, Caroline B. Foote, Paul J. Wang, Antonis S. Manolis, N. A. Mark Estes

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Surgical ablation of the arrhythmogenic focus in patients with life-threatening ventricular tachyarrhythmias can be curative. However, the surgical techniques have been plagued by a high perioperative mortality rate (averaging ≃12%). Reconstruction of the left ventricle may reduce mortality. Methods and Results: Reconstruction of the left ventricle with a pericardial patch, or endoaneurysmorrhaphy, was performed with mapping- guided subendocardial resection for recurrent ventricular tachycardia in 25 patients over a 5-year period. Postoperatively, electrophysiological studies were conducted to assess the results of surgery, which were further evaluated during long-term follow-up with survival analyses. The study included 25 patients, 60±9 years of age, with coronary artery disease, discrete left ventricle aneurysms, and malignant ventricular tachyarrhythmias. Left ventricular ejection fraction was 24±6% preoperatively. Left ventricular endocardial mapping, endocardial resection, and endoaneurysmorrhaphy were performed in all patients. There was no operative or postoperative (30-day) mortality. Postoperative ventricular tachycardia was induced in 2 of the 25 patients (8%); left ventricular function increased to 32±9% (range, 19% to 52%). At a mean follow-up of 37±16 months (range, 6 to 65 months), there had been 6 deaths, including 1 sudden cardiac death, 2 congestive heart failure deaths, and 3 noncardiac deaths. Analysis of multiple variables failed to identify predictors of postoperative inducibility, sudden cardiac death, cardiac death, or total mortality. Conclusions: Endoaneurysmorrhaphy with a pericardial patch combined with mapping-guided subendocardial resection frequently cures recurrent ventricular tachycardia with low operative mortality and improvement of ventricular function. Long-term follow-up demonstrates low sudden cardiac death rates.

Original languageEnglish (US)
Pages (from-to)1041-1048
Number of pages8
JournalCirculation
Volume94
Issue number5
DOIs
StatePublished - Jan 1 1996

Fingerprint

Mortality
Sudden Cardiac Death
Ventricular Tachycardia
Heart Ventricles
Tachycardia
Ventricular Function
Survival Analysis
Left Ventricular Function
Stroke Volume
Aneurysm
Coronary Artery Disease
Heart Failure

Keywords

  • ablation
  • aneurysm
  • mapping
  • surgery
  • tachyarrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Perioperative and long-term results with mapping-guided subendocardial resection and left ventricular endoaneurysmorrhaphy. / Rastegar, Hassan; Link, Mark S.; Foote, Caroline B.; Wang, Paul J.; Manolis, Antonis S.; Mark Estes, N. A.

In: Circulation, Vol. 94, No. 5, 01.01.1996, p. 1041-1048.

Research output: Contribution to journalArticle

Rastegar, Hassan ; Link, Mark S. ; Foote, Caroline B. ; Wang, Paul J. ; Manolis, Antonis S. ; Mark Estes, N. A. / Perioperative and long-term results with mapping-guided subendocardial resection and left ventricular endoaneurysmorrhaphy. In: Circulation. 1996 ; Vol. 94, No. 5. pp. 1041-1048.
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abstract = "Background: Surgical ablation of the arrhythmogenic focus in patients with life-threatening ventricular tachyarrhythmias can be curative. However, the surgical techniques have been plagued by a high perioperative mortality rate (averaging ≃12{\%}). Reconstruction of the left ventricle may reduce mortality. Methods and Results: Reconstruction of the left ventricle with a pericardial patch, or endoaneurysmorrhaphy, was performed with mapping- guided subendocardial resection for recurrent ventricular tachycardia in 25 patients over a 5-year period. Postoperatively, electrophysiological studies were conducted to assess the results of surgery, which were further evaluated during long-term follow-up with survival analyses. The study included 25 patients, 60±9 years of age, with coronary artery disease, discrete left ventricle aneurysms, and malignant ventricular tachyarrhythmias. Left ventricular ejection fraction was 24±6{\%} preoperatively. Left ventricular endocardial mapping, endocardial resection, and endoaneurysmorrhaphy were performed in all patients. There was no operative or postoperative (30-day) mortality. Postoperative ventricular tachycardia was induced in 2 of the 25 patients (8{\%}); left ventricular function increased to 32±9{\%} (range, 19{\%} to 52{\%}). At a mean follow-up of 37±16 months (range, 6 to 65 months), there had been 6 deaths, including 1 sudden cardiac death, 2 congestive heart failure deaths, and 3 noncardiac deaths. Analysis of multiple variables failed to identify predictors of postoperative inducibility, sudden cardiac death, cardiac death, or total mortality. Conclusions: Endoaneurysmorrhaphy with a pericardial patch combined with mapping-guided subendocardial resection frequently cures recurrent ventricular tachycardia with low operative mortality and improvement of ventricular function. Long-term follow-up demonstrates low sudden cardiac death rates.",
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N2 - Background: Surgical ablation of the arrhythmogenic focus in patients with life-threatening ventricular tachyarrhythmias can be curative. However, the surgical techniques have been plagued by a high perioperative mortality rate (averaging ≃12%). Reconstruction of the left ventricle may reduce mortality. Methods and Results: Reconstruction of the left ventricle with a pericardial patch, or endoaneurysmorrhaphy, was performed with mapping- guided subendocardial resection for recurrent ventricular tachycardia in 25 patients over a 5-year period. Postoperatively, electrophysiological studies were conducted to assess the results of surgery, which were further evaluated during long-term follow-up with survival analyses. The study included 25 patients, 60±9 years of age, with coronary artery disease, discrete left ventricle aneurysms, and malignant ventricular tachyarrhythmias. Left ventricular ejection fraction was 24±6% preoperatively. Left ventricular endocardial mapping, endocardial resection, and endoaneurysmorrhaphy were performed in all patients. There was no operative or postoperative (30-day) mortality. Postoperative ventricular tachycardia was induced in 2 of the 25 patients (8%); left ventricular function increased to 32±9% (range, 19% to 52%). At a mean follow-up of 37±16 months (range, 6 to 65 months), there had been 6 deaths, including 1 sudden cardiac death, 2 congestive heart failure deaths, and 3 noncardiac deaths. Analysis of multiple variables failed to identify predictors of postoperative inducibility, sudden cardiac death, cardiac death, or total mortality. Conclusions: Endoaneurysmorrhaphy with a pericardial patch combined with mapping-guided subendocardial resection frequently cures recurrent ventricular tachycardia with low operative mortality and improvement of ventricular function. Long-term follow-up demonstrates low sudden cardiac death rates.

AB - Background: Surgical ablation of the arrhythmogenic focus in patients with life-threatening ventricular tachyarrhythmias can be curative. However, the surgical techniques have been plagued by a high perioperative mortality rate (averaging ≃12%). Reconstruction of the left ventricle may reduce mortality. Methods and Results: Reconstruction of the left ventricle with a pericardial patch, or endoaneurysmorrhaphy, was performed with mapping- guided subendocardial resection for recurrent ventricular tachycardia in 25 patients over a 5-year period. Postoperatively, electrophysiological studies were conducted to assess the results of surgery, which were further evaluated during long-term follow-up with survival analyses. The study included 25 patients, 60±9 years of age, with coronary artery disease, discrete left ventricle aneurysms, and malignant ventricular tachyarrhythmias. Left ventricular ejection fraction was 24±6% preoperatively. Left ventricular endocardial mapping, endocardial resection, and endoaneurysmorrhaphy were performed in all patients. There was no operative or postoperative (30-day) mortality. Postoperative ventricular tachycardia was induced in 2 of the 25 patients (8%); left ventricular function increased to 32±9% (range, 19% to 52%). At a mean follow-up of 37±16 months (range, 6 to 65 months), there had been 6 deaths, including 1 sudden cardiac death, 2 congestive heart failure deaths, and 3 noncardiac deaths. Analysis of multiple variables failed to identify predictors of postoperative inducibility, sudden cardiac death, cardiac death, or total mortality. Conclusions: Endoaneurysmorrhaphy with a pericardial patch combined with mapping-guided subendocardial resection frequently cures recurrent ventricular tachycardia with low operative mortality and improvement of ventricular function. Long-term follow-up demonstrates low sudden cardiac death rates.

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