Perioperative and long-term results with mapping-guided subendocardial resection and left ventricular endoaneurysmorrhaphy

Background: Surgical ablation of the arrhythmogenic focus in patients with life-threatening ventricular tachyarrhythmias can be curative. However, the surgical techniques have been plagued by a high perioperative mortality rate (averaging ≃12%). Reconstruction of the left ventricle may reduce mortality. Methods and Results: Reconstruction of the left ventricle with a pericardial patch, or endoaneurysmorrhaphy, was performed with mapping- guided subendocardial resection for recurrent ventricular tachycardia in 25 patients over a 5-year period. Postoperatively, electrophysiological studies were conducted to assess the results of surgery, which were further evaluated during long-term follow-up with survival analyses. The study included 25 patients, 60±9 years of age, with coronary artery disease, discrete left ventricle aneurysms, and malignant ventricular tachyarrhythmias. Left ventricular ejection fraction was 24±6% preoperatively. Left ventricular endocardial mapping, endocardial resection, and endoaneurysmorrhaphy were performed in all patients. There was no operative or postoperative (30-day) mortality. Postoperative ventricular tachycardia was induced in 2 of the 25 patients (8%); left ventricular function increased to 32±9% (range, 19% to 52%). At a mean follow-up of 37±16 months (range, 6 to 65 months), there had been 6 deaths, including 1 sudden cardiac death, 2 congestive heart failure deaths, and 3 noncardiac deaths. Analysis of multiple variables failed to identify predictors of postoperative inducibility, sudden cardiac death, cardiac death, or total mortality. Conclusions: Endoaneurysmorrhaphy with a pericardial patch combined with mapping-guided subendocardial resection frequently cures recurrent ventricular tachycardia with low operative mortality and improvement of ventricular function. Long-term follow-up demonstrates low sudden cardiac death rates.