Surgical ventricular restoration versus isolated coronary artery bypass grafting for left ventricular aneurysm: comparison of mid- to long-term outcomes / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the mid- to long-term outcomes of patients receiving isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) plus CABG for left ventricular aneurysms.</p><p><b>METHODS</b>The clinical data were retrospectively analyzed in 205 patients with left ventricular aneurysms admitted to our hospital between January, 1997 and December, 2012, including 115 patients receiving SVR plus CABG and 90 undergoing isolated CABG. By matching preoperative echocardiographic parameters including aneurysm size, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index (LVESVI) and EuroSCORE risk factors, 32 patients receiving SVR plus CABG and another 32 with isolated CABG were enrolled in this study. The patients were compared for survival rates, major adverse cardiac or cerebrovascular events (MACCEs), left ventricular geometry and function at 1, 3 and 5 years of follow-up.</p><p><b>RESULTS</b>Compared with the patients receiving isolated CABG, those receiving SVR and CABG showed greater improvements in echocardiographic parameters and NYHA functional class. The differences in the echocardiographic parameters between the two groups gradually reduced with time and became comparable at 5 years after the operation (P>0.05). No significant difference was found in the mid- to long-term survival or the incidence of MACCEs between the two groups (P>0.05).</p><p><b>CONCLUSION</b>Compared with isolated CABG, SVR plus CABG does not reduce the incidence of MACCEs or improve the mid- to long-term survival rate of patients with left ventricular aneurysm with a LVESVI <60 mL/m(2).</p>

Clinical analysis of reoperation for paravalvular leakage in 28 patients / 解放军医学杂志

Objective To observe surgical outcome of reoperation for paravalvular leakage and medium- and long-term survival. Methods The clinical data of 28 patients receiving reoperation for paravalvular leak (PVL) in General Hospital of PLA between October 1998 and October 2015. The patients included 22 males and 6 females, with a mean age of 55.3 years (ranging from 15-67 years). PVL was reported in 18 cases after mitral valve replacement, in 4 after aortic valve replacement, in 4 after multiple valve replacement (mitral PVL), in 1 case after multiple valve replacement (multiple PVL) and in 1 after radical surgery for trilogy of Fallot with tricuspid valve replacement (tricuspid PVL). There were 2 cases diagnosed as infective endocarditis contributing to PVL. The grades of heart function were NYHA II in 11 patients, NYHA III in 10, NYHA IV in 7. Results Two patients died in hospital because of septic shock and MODS respectively. One patient developed hypoxic-ischemic encephalopathy after operation. There were 2 patients undergoing second thoracotomy on account of drainage post-operatively. One patient suffered recurrence of PVL. Twenty-two out of 26 patients were followed-up for 12 to 219 months (average 76.21 months) and 4 were lost to follow-up. One patient died of severe pancreatitis 31 months after hospital discharge and 1 had recurrence of PVL with heart function NYHA III. Twenty-four survivals are in NYHA class II. Conclusion Aggressive operation is effective treatment for moderate-severe PVL diagnosed by cardiac ultrasonography.