[Resection of left ventricular aneurysm for clinical heart failure. Long-term results and prognostic factors (author's transl)].

Between 1970 and 1980, 46 resections of left ventricular aneurysm were carried out in patients with clinical evidence of heart failure but without associated septal perforation or severe mitral regurgitation. Aortocoronary bypass was simultaneously performed in 28% of the cases. The mean post-operative follow-up was 67 months. The early (1 mont) post-operative mortality rate was 15.2%. The actuarial survival rate (taking into account the early post-operative mortality rate) was 52.4% at 5 years and 32.9% at 10 years. Most early and late deaths were of cardiac origin. Among long-term survivors, 48.5% had no post-operative heart failure and 67% had no residual angina pectoris. In a statistical analysis of the factors involved in overall post-operative survival, no significant influence could be found for sex and age (within the limits of the study), risk factors associated with atheroma, duration of the myocardial necrosis responsible for the aneurysm, location of the aneurysm, time taken for the post-infarction heart failure to develop, presence of pre-operative angina on ECG, number of coronary arteries stenosed, extent of the aneurysm as determined by cineventriculography, cardiac index, left ventricular end-systolic pressure and associated aortocoronary bypass. In contrast, a significant prognostic value was demonstrated for the ejection fraction of the contractile area of the left ventricle (p less than 0.02), the maximal cardiac dysfunction observed prior to surgery (P less than 0.02), the presence of pre-operative dysrhythmias (P less than 0.1) and the quality of cardiac performance recovered immediately after the operation (P less than 0.001).