Objective : To evaluate the efficacy of left ventricular (LV) endoaneurysmoraphy and cryoablation without electrophysiologic mapping for ventricular tachycardias (VT) in patients (pts) with postinfarct LV aneurysm.
Methods : Prospective analysis of all 18 pts operated between April 1996 and May 2000 for malignant VT in the presence of a resectable LV aneurysm.
Results : The study population consisted of 11 men and 7 women, mean age 64 y (50-84). Sustained monomorphic VT was present in all pts, VT was incessant in 4. Sixrteen pts had anterior wall MI and 2 pts inferior wall MI. Six pts had three vessel coronary artery disease (CAD), 4 pts two vessel CAD and 8 pts single vessel CAD.
Mean pre-op ejection fraction was 31 % (8-52), mean enddiastolic volume index was 144 ml/m² (101 – 216 ml/m²).
All pts underwent extensive cryoablation at the transition zone of scar and viable tissue together with LV endoaneurysmoraphy in 16 pts and direct closure in 2 pts. Eleven pts underwent associated CABG and 1 pt mitral valve reconstruction.
At postop EP study 16 pts were not inducible and 2 pts were inducible without clinical recurrence of VT at follow-up. Early mortality was 0 %. One patient received ICD and 2 pts underwent pacemakerimplantation after EP study.
After mean follow-up of 18 months (1 - 48), 7 pts were in NYHA class I, 11 pts in NYHA class 2 and no mortality, no readmission for VT, no ICD implantation was noted.
Conclusion : In pts suffering from VT in the presence of a complicated post infarct LV aneurysm, combined “blind” cryoablation and endoaneurymoraphy offers sustained freedom of VT and excellent clinical and hemodynamic outcome.