Results of surgical treatment for left ventricular postinfarction aneurysms combined with mitral valve insufficiency
Objective. The aim of the study was to evaluate the results of surgical treatment for mitral insufficiency (MI) using left atrial and transventricular approaches in patients with left ventricular (LV) postinfarction aneurysms. Material and methods. 108 patients with ischemic heart disease underwent resection of LV postinfarction aneurysms and unimplanted mitral valve (MV) plasty with or without coronary artery bypass grafting between 2003 and 2012. Correction of mitral valve insufficiency was carried out via left atrial approach in 56 patients and via transventricular approach - in 52 patients who underwent left ventricle reconstruction. Results. Surgical reconstruction of left ventricle included linear plasty of LV aneurysm or endoventriculoplasty with autopericardial patch or endoventriculoplasty with purse-string Jatene suture. All patients underwent unimplanted mitral valve plasty. Coronary artery bypass surgery performed in 55 (98.2%) patients from group I and in 51 (98.1%) patients from group II (p>0.05). Postoperative echocardiographic data showed significant decrease in left ventricle volume, left atrial size, mitral annu-lus and estimated pressure in pulmonary artery in both groups. 91.1% patients from group I and 92.3% patients from group II (p>0.05) had no MI or had MI of no greater than grade I. Rate of hospital mortality was 4.6% (n=5). Conclusion. Absence of difference in MI grade after surgery, acceptable results after MV correction along with comparable rates of hospital mortality, low ejection fraction syndrome and requirement in intra-aortic balloon pumping confirm the adequacy of both approaches for MI correction. Surgical treatment in such severe patients is multicomponent and technically sophisticated. Ability and comfortability of MV plasty with transventricular approach is associated with its sizes and aneurysm location and, therefore, facilitate to choose the technique for LV aneurysm plasty. Advantages of different approaches to MV are questionable and the approach must be determined according to given anatomy of LV remodeling and experience of the surgeon.