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A single center’s experience with total arterial revascularization and spiral aneurysmorrhaphy for ischemic cardiac disease

  • Ilias P. Doulamis
  • Despina N. Perrea
  • George Mastrokostopoulos
  • Konstantina Drakopoulou
  • Konstantinos Voutetakis
  • Aspasia Tzani
  • Ioannis A. Chloroyiannis
Original Article
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Abstract

The restoration of left ventricular (LV) geometry in combination with coronary artery bypass grafting for the treatment of ischemic cardiac disease remains controversial. We hereby present the experience of our center with total arterial myocardial revascularization (TAMR) and spiral aneurysmorrhaphy for ischemic heart disease. A retrospective analysis of 101 patients with advanced cardiovascular disease who underwent TAMR and spiral aneurysmorrhaphy was performed. Spiral aneurysmorrhaphy is a modification of the linear aneurysmorrhaphy and was applied to patients who had a LV aneurysm with a diameter of less than 5 cm. Peri-operative and in-hospital data were retrieved. The majority of the patients were male (87.13%) with a mean age of 63.1 years. Mean pre-operative ejection fraction (EF) was 35.7% ranging between 20 and 65%. An average of 3.23 grafts was required per patient. Early mortality was 6.93% (one intra-operative and six in-hospital deaths). Addition of concomitant valve surgery was associated with prolonged total operative, cardiopulmonary bypass and cross-clamp time (p < 0.001), increased need for blood (p = 0.012) and plasma (p = 0.038), longer intensive care unit (ICU) stay (p = 0.045) and higher rate of post-operative cerebrovascular accident (p = 0.011). Furthermore, patients with a pre-operative EF between 30 and 50% had a shorter ICU stay (p = 0.045) and LoS (p = 0.029) compared with patients with EF <30%. Early mortality and post-operative complication rates following this combined procedure are in consistency with the relevant available data suggesting its feasibility regardless of the EF or addition of concomitant surgeries. Data from the follow-up of these patients are required to examine the long-term efficacy of this surgical modality.

Keywords

Total arterial revascularization Aneurysmorrhaphy Ischemic heart disease Left ventricular aneurysm 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Ilias P. Doulamis
    • 1
  • Despina N. Perrea
    • 1
  • George Mastrokostopoulos
    • 2
  • Konstantina Drakopoulou
    • 2
  • Konstantinos Voutetakis
    • 3
  • Aspasia Tzani
    • 1
  • Ioannis A. Chloroyiannis
    • 3
  1. 1.Laboratory for Experimental Surgery and Surgical Research “N.S Christeas”, Athens Medical SchoolNational and Kapodistrian University of AthensAthensGreece
  2. 2.Department of Cardiac AnesthesiaEuroclinic of AthensAthensGreece
  3. 3.Department of Cardiac SurgeryEuroclinic of AthensAthensGreece

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