Technical advances in the treatment of left ventricular aneurysm.

The resulting abnormal geometry after surgical treatment of left ventricular aneurysm has concerned a number of surgeons since the first successful repair in 1958, but little attention was placed on the altered geometry until attempts were made to effect a more physiologic aneurysmorrhaphy in 1973. Substantial attention was focused on a concept of geometric reconstruction from within the left ventricle in 1985. A prosthetic patch was employed with the concept to redirect normal muscle bundles to their original orientation and position. Further refinements include use of improved materials for the repair, preservation and bypass of the left anterior descending coronary artery, ablation of ventricular arrhythmias when indicated, and the absence of prosthetic material used in contact with the pericardial surface. Our experience with repair of 61 left ventricular aneurysms at West Jefferson Medical Center over a 4 1/2-year period with a 3.3% mortality rate has prompted a change from the standard linear repair to routine use of a modified endoventricular repair. Currently, the low surgical risk due to advances in left ventricular aneurysmorrhaphy combined with the knowledge that contractile areas will progressively deteriorate in ventricles stressed by poor hemodynamics and with data showing improved left ventricular function postoperatively have led to more liberal recommendations for early left ventricular aneurysm repair.