Left Ventricular Aneurysm Repair Through the Left Anterior Minithoracotomy.

Abstract

Objective: To describe the technique and the results of left ventricular aneurysm (LVA) repair with simultaneous coronary artery bypass grafting (CABG) and/or mitral valve (MV) surgery through the left anterior thoracotomy.

Methods: Between October 2018 and June 2024, a cohort of 40 patients underwent repair for postinfarction LVA through left anterior thoracotomy. Simultaneous procedures included CABG (40 patients, 100%) and MV surgery (15 patients, 37.5%) and were performed through the same thoracotomy incision. The mean age of the patients was 61.4 ± 11.4 years (range, 33 to 82 years), the mean body mass index was 27.9 ± 4.3 kg/m² (range, 19.9 to 35.9 kg/m²), and the mean LV ejection fraction was 29.9% ± 8.6% (range, 10% to 55%). The surgical technique in all patients included peripheral cardiopulmonary bypass, minithoracotomy in the fourth intercostal space, aortic cross-clamping, and cold blood cardioplegia.

Results: Successful visualization and repair of the LVA and complete revascularization was achieved in all patients without conversion to sternotomy. The mean number of distal anastomoses per patient was 2.03 ± 1.12 (range, 1 to 5). The mean cardiopulmonary bypass time was 207 ± 51.0 min, and the mean cross-clamp time was 115.5 ± 28.7 min. The average intensive care unit stay was 2.1 ± 1.4 days (range, 1 to 8 days), and the total hospital stay was 6.8 ± 2.9 days (range, 4 to 14 days). No strokes, major complications, or hospital mortality were observed. The 30-day mortality included 1 patient.

Conclusions: LVA repair (isolated or combined with simultaneous cardiac surgical procedures) through the left anterior thoracotomy is shown to be efficient and safe in our experience.