Long-term results of surgical treatment of patients with postinfarction left ventricular aneurysm with coronary artery disease

Abstract

Aim – To assess the 5-year survival rates and factors associated with adverse outcomes following left ventricular geometric reconstruction (LVGR).

Material and methods. This retrospective study included 173 patients who underwent LVGR at Bakoulev National Medical Research Center of Cardiovascular Surgery from 2012 to 2022. Long-term follow-up was available for 161 patients, who were stratified into two groups based on their 5-year outcome: survivors and non-survivors. The primary endpoint was all-cause mortality within 5 years after the procedure, including in-hospital mortality. Survival and risk factors for long-term mortality were analyzed. Statistical processing was performed using IBM SPSS Statistics v.26 and StatTech v.3.1.8.

Results. The early postoperative mortality rate was 7%. The 5-year survival rate was 89.7% (95% CI 82.4–93.5). Key predictors of adverse outcomes were hemodynamic and intraoperative factors. Each 1 mL/m² increase in the end-diastolic volume index (EDVI) was associated with a 7.4% increase in the risk of death, while postoperative mitral regurgitation ≥ grade 2.5 increased the risk by a factor of 18.16. Excessive reduction of left ventricular volumes (ΔEDV >55 mL, ΔEDVI >26 mL/m²) was also associated with a worse prognosis, underscoring the importance of balancing reverse remodeling with the preservation of myocardial functional reserve. Intraoperative parameters, such as cardiopulmonary bypass time >136 minutes and aortic cross-clamp (ACC) time >70 minutes, significantly worsened outcomes (p<0.001). Heart failure requiring intra-aortic balloon pump (IABP) support increased mortality risk by a factor of 7.3, reflecting the critical condition of patients requiring mechanical circulatory support. A postoperative ejection fraction <43% and a stroke index <33 mL/m² served as independent markers of an unfavorable prognosis.

Conclusion. The study demonstrated that the 5-year survival rate for patients discharged after LVGR surgery was 89.7%. Independent risk factors for long-term mortality, identified by multivariate Cox regression analysis, were: Δ end-systolic volume index (ΔESVI, mL/m²), Δ end-diastolic volume index (ΔEDVI, mL/m²), postoperative mitral regurgitation (grade), aortic cross-clamp time (min), and acute heart failure requiring IABP support. A prognostic model incorporating these independent risk factors was developed to predict the risk of mortality in patients within 5 years after LVGR surgery.