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Eur J Cardiothorac Surg 2002;22:771-776
© 2002 Elsevier Science NL

Surgical treatment of tachyarrhythmias due to postinfarction left ventricular aneurysm with endoaneurysmorrhaphy and cryoablation

^a Department of Cardiovascular and Thoracic Surgery, Onze-Lieve-Vrouw Clinic, Moorselbaan 164, 9300 Aalst, Belgium
^b Department of Cardiology, Onze-Lieve-Vrouw Clinic, Aalst, Belgium
^c Department of Cardiovascular Surgery, Kadir Has University, Florence Nightingale Hospital, Istanbul, Turkey

Received 11 September 2001; received in revised form 10 June 2002; accepted 14 June 2002.

* Corresponding author. Tel.: +32-53-72-45-99; fax: +32-53-72-45-52
e-mail: francis.wellens{at}olvz-aalst.be

Objective: In this study, the efficacy of left ventricular (LV) endoaneurysmorrhaphy and cryoablation without intraoperative electrophysiologic mapping was evaluated in patients with postinfarction LV aneurysm and sustained ventricular tachycardia (VT). Methods: A prospective study was performed on all patients operated with malignant VT in the presence of a resectable LV aneurysm between July 1990 and February 2001. Results: The study included 31 patients, 20 men and 11 women, with a mean age of 65.5 years (47–84). Monomorphic, polymorphic VT or ventricular fibrillation was present in all patients prospectively, and VT was incessant in 11. Twenty-six patients had an anterior, four patients had an inferior and one patient a posterolateral myocardial wall infarction. All patients had a well-limited ventricular aneurysm. Ten patients had three, eight patients two and 13 patients had single vessel coronary artery disease. Mean preoperative ejection fraction was 34.8±14.5% (8–62) and mean end-diastolic volume index was 141.5±51.8 ml/m² (57–288). Six patients had mitral regurgitation grade III or IV. All patients underwent extensive cryoablation at the transition zone of scar and viable tissue and LV remodelling with prosthetic patch in 26 patients. Associated procedures were CABG in 19 patients (61%) and mitral valve reconstruction in six patients (19%). Postoperative electrophysiologic study (EPS) revealed freedom from VT induction in 25 patients and inducible VT in five patients. One patient had inducible polymorphic VT. Five patients received an implantable cardioverter defibrillator (ICD) and three patients had a permanent pacemaker implanted. After a mean follow-up of 30±27 months (6–132) there was one arrhythmia-related death. There was one early hospital readmission for clinical VT and no need for late ICD implantation. Conclusions: In patients suffering from ventricular arrhythmias in the presence of a complicated postinfarction LV aneurysm, combined ‘blind’ cryoablation and endoaneurysmorrhaphy offers excellent arrhythmia control and clinical and haemodynamic outcome.

Key Words: Cryoablation • Ventricular tachycardia • Left ventricular aneurysm • Sudden death • Myocardial infarction

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