The treatment of refractory ischemic ventricular tachycardia by endoventricular patch plasty reconstruction of the left ventricle.

Although the endoventricular patch plasty technique was originally developed to improve the functional status of the left ventricle following resection of an aneurysm, it became apparent early on in our experience that the technique also cured most cases of ventricular tachycardia associated with these aneurysms. As a result, we began to include as a part of our preoperative work-up an electrophysiology study in which we attempted to induce ventricular tachycardia even if it had not occurred spontaneously. Using our standard surgical approach, plus the use of cryotherapy, we have now operated on 106 patients with either spontaneous or inducible ventricular tachycardia preoperatively in association with ventricular dyskinesia or akinesia. The operative mortality in this series of patients was 7.5%. Postoperatively, ventricular tachycardia could not be induced in 92% of the survivors and only 2 patients have had episodes of spontaneous ventricular tachycardia. Because this technique does not require any intraoperative electrophysiological mapping, we believe this to be an excellent surgical approach for patients with refractory ischemic ventricular tachycardia.