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(Circulation. 1996;94:1041-1048.)
© 1996 American Heart Association, Inc.

Articles

Perioperative and Long-term Results With Mapping-Guided Subendocardial Resection and Left Ventricular Endoaneurysmorrhaphy

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

the Cardiac Arrhythmia Service, New England Medical Center Hospital, Divisions of Cardiology and Surgery, Tufts University School of Medicine, Boston, Mass.

Correspondence to N.A. Mark Estes III, MD, Director, Arrhythmia Service, Tufts/New England Medical Center, 750 Washington St, Boston, MA 02111. E-mail N.A.Estes@Card@NEMC.

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.

Key Words: ablation • aneurysm • mapping • surgery • tachyarrhythmias

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