Mechanical complications of acute MI

Question 1

LV Aneurysm

Indications for Surgery

Answer 1

1. Ongoing angina
2. Heart failure despite medical therapy
3. arrythmias (ventricular)
4. Associated thromboembolic event

Relative indication:
End-systolic volume index > 80mL/m2
end-diastolic volume >120mL

Question 2

LV Aneurysm

Important surgical principles to keep in mind

Answer 2

1. identification of the akinetic LV segment (will dimple after LV decompression)
2. minimal manipulation of the LV prior to application of the aortic cross-clamp to avoid dislodging any LV thrombus (if present).

Coronary artery bypass grafting (CABG) is also typically performed during these operations.
The mitral valve may need to be repaired concomitantly and this is generally done with mitral annuloplasty.

Question 3

LV Aneurysm

RESTORE Study findings

Answer 3

• The RESTORE study demonstrated that LV aneurysm resection or surgical ventricular reconstruction (SVR) improved postoperative EF, NYHA Class, and LV end-systolic volume.

In this study, concomitant CABG and mitral valve repair were performed in 95% and 22% of patients, respectively.

Question 4

LV Aneurysm

STITCH Trial findings

Answer 4

• The controversial STICH trial showed no difference in mortality of patients undergoing CABG alone versus patients undergoing CABG with LV remodeling.
• The type of repair did not affect the outcome.