Long-term outcomes for repair of inferolateral left ventricular pseudoaneurysm via the endocardial exclusion patch technique

Abstract

Objectives

Left ventricular pseudoaneurysms are a rare complication of myocardial infarction, endocarditis, or iatrogenic injury. Urgent surgical intervention is necessary given the high risk of expansion or life-threatening rupture. Defects on the posterior, inferolateral wall of the ventricle can be particularly challenging to repair with standard epicardial approaches due to difficulty with obtaining adequate exposure and postrepair hemostasis.

Methods

We retrospectively identified adult patients at a quaternary referral center who underwent repair of left ventricular pseudoaneurysm via an endocardial exclusion patch between January 2017 to September 2024. Chart review was performed to obtain individual indications, operative technique, and postoperative outcomes.

Results

A total of 6 patients were identified. Three (50%) patients had undergone previous cardiac operations, including coronary bypass (n = 1), mitral valve replacement (n = 1), or both (n = 1). Etiologies of the pseudoaneurysms were ischemic (n = 3), infectious (n = 2), or mixed (n = 1). Concomitant mitral valve and/or coronary artery intervention was performed in 5 (86%) cases. There was 100% obliteration of the pseudoaneurysm sac on follow-up imaging and 100% survival to most recent follow-up (median, 1035 days).

Conclusions

An endocardial patch exclusion technique is technically feasible with safe and durable outcomes; potential benefits of this approach include minimizing dissection in reoperative fields, avoidance of previous coronary bypass grafts, and improved hemostasis with no exposed epicardial suture lines.