Long-term surgical results in sudden death syndrome associated with cardiac dysfunction after myocardial infarction

Hooshang Bolooki, Michael D. Horowitz, Alberto Interian, Richard J Thurer, George M. Palatianos, Eduardo De Marchena, Richard A. Perryman, Robert J Myerburg

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

To evaluate the surgical results in patients with inducible ventricular tachyarrhythmias due to coronary disease and left ventricular dysfunction, the authors reviewed their experience in 170 patients who had survived one or more cardiac arrests after myocardial infarction and were unresponsive to drug therapy based on electrophysiologic studies (EPS). There were nine operative deaths (5%). Based on intraoperative EPS, surgical remodeling of left ventricular dysfunction (aneurysm resection, infarct debulking, and septal reinforcement) with map-guided cryoablation and coronary artery bypass graft was performed in 34 patients (group A), and left ventricular remodeling and coronary artery bypass graft without guided endocardial resection was performed in 25 patients (group B). Forty-three patients (group C) had coronary artery bypass graft with implantation of an automatic implantable cardioverter defibrillator (AICD). Group D (68 patients) received AICD only. After operation, based on EPS results, four patients in group A (12%) and three patients in Group B (15%) required AICD implantation. Overall survival at 6 years was 65%, 48%, 85%, and 58% in patient groups A, B, C, and D, respectively (p = not significant). During follow-up in group A patients, none died suddenly and none needed AICD. In group B, two patients required AICD 3 and 5 years later, and five patients died suddenly. The incidence of sudden death was 2.3%/patient/year and 3.5%/patient/year after AICD implantation (groups C and D). At 6 years, cardiac-event-free survival was 80% and 70% for groups A and B and 38% and 24% for groups C and D, respectively (p < 0.001). Patients receiving map-guided ablative procedures had significantly improved cardiac-event-free survival rates.

Original languageEnglish
Pages (from-to)333-341
Number of pages9
JournalAnnals of Surgery
Volume216
Issue number3
StatePublished - Dec 1 1992

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Sudden Death
Myocardial Infarction
Implantable Defibrillators
Coronary Artery Bypass
Left Ventricular Dysfunction
Transplants
Disease-Free Survival
Cryosurgery
Ventricular Remodeling
Heart Arrest
Tachycardia
Aneurysm
Coronary Disease
Survival Rate

ASJC Scopus subject areas

  • Surgery

Cite this

Long-term surgical results in sudden death syndrome associated with cardiac dysfunction after myocardial infarction. / Bolooki, Hooshang; Horowitz, Michael D.; Interian, Alberto; Thurer, Richard J; Palatianos, George M.; De Marchena, Eduardo; Perryman, Richard A.; Myerburg, Robert J.

In: Annals of Surgery, Vol. 216, No. 3, 01.12.1992, p. 333-341.

Research output: Contribution to journalArticle

Bolooki, H, Horowitz, MD, Interian, A, Thurer, RJ, Palatianos, GM, De Marchena, E, Perryman, RA & Myerburg, RJ 1992, 'Long-term surgical results in sudden death syndrome associated with cardiac dysfunction after myocardial infarction', Annals of Surgery, vol. 216, no. 3, pp. 333-341.
Bolooki H, Horowitz MD, Interian A, Thurer RJ, Palatianos GM, De Marchena E et al. Long-term surgical results in sudden death syndrome associated with cardiac dysfunction after myocardial infarction. Annals of Surgery. 1992 Dec 1;216(3):333-341.
Bolooki, Hooshang ; Horowitz, Michael D. ; Interian, Alberto ; Thurer, Richard J ; Palatianos, George M. ; De Marchena, Eduardo ; Perryman, Richard A. ; Myerburg, Robert J. / Long-term surgical results in sudden death syndrome associated with cardiac dysfunction after myocardial infarction. In: Annals of Surgery. 1992 ; Vol. 216, No. 3. pp. 333-341.
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abstract = "To evaluate the surgical results in patients with inducible ventricular tachyarrhythmias due to coronary disease and left ventricular dysfunction, the authors reviewed their experience in 170 patients who had survived one or more cardiac arrests after myocardial infarction and were unresponsive to drug therapy based on electrophysiologic studies (EPS). There were nine operative deaths (5{\%}). Based on intraoperative EPS, surgical remodeling of left ventricular dysfunction (aneurysm resection, infarct debulking, and septal reinforcement) with map-guided cryoablation and coronary artery bypass graft was performed in 34 patients (group A), and left ventricular remodeling and coronary artery bypass graft without guided endocardial resection was performed in 25 patients (group B). Forty-three patients (group C) had coronary artery bypass graft with implantation of an automatic implantable cardioverter defibrillator (AICD). Group D (68 patients) received AICD only. After operation, based on EPS results, four patients in group A (12{\%}) and three patients in Group B (15{\%}) required AICD implantation. Overall survival at 6 years was 65{\%}, 48{\%}, 85{\%}, and 58{\%} in patient groups A, B, C, and D, respectively (p = not significant). During follow-up in group A patients, none died suddenly and none needed AICD. In group B, two patients required AICD 3 and 5 years later, and five patients died suddenly. The incidence of sudden death was 2.3{\%}/patient/year and 3.5{\%}/patient/year after AICD implantation (groups C and D). At 6 years, cardiac-event-free survival was 80{\%} and 70{\%} for groups A and B and 38{\%} and 24{\%} for groups C and D, respectively (p < 0.001). Patients receiving map-guided ablative procedures had significantly improved cardiac-event-free survival rates.",
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