Results of surgical treatment of patients with chronic heart failure and postinfarction left ventricular aneurysm type IV according to L. Menikanti classification

Introduction. In 2003, at the Annual Congress of the American Heart Association in Orlando, L. Menicanti and M. Di Donato proposed an original morphofunctional classification of postinfarction left ventricular aneurysms based on the silhouette and segmental contractility of the LV wall. According to this classification, 4 types of aneurysms are distinguished. Type 4 is akinesis of the anterolateral, apical and posterobasal segments, the presence of residual contractility of the anterobasal and inferoapical segments («double scar»). The combination of anterior and posterior LV aneurysms is one of the rarest complications, and the incidence rate of less than 1 % is due to high mortality in the acute period of MI [2–4]. Objective . To evaluate the results of surgical treatment of patients with post-infarction left ventricular aneurysm type IV according to the classification of L. Menicanti. Materials and methods . In this retrospective single-center study, we examined the medical records of 37 patients who underwent simultaneous reconstruction of the anterior and posterior LV aneurysm, coronary artery bypass grafting and mitral valve plastic surgery from 2010 to 2024 at the Federal Center for Cardiovascular Surgery in Penza. The main inclusion criteria were: coronary heart disease and the presence of an aneurysm type IV (a combination of anterior and posterior aneurysms) according to the classification of L. Menicanti. Results . In the period from January 2010 to 2024, 37 operations were performed, which consisted of geometric remodeling of post-infarction LV aneurysm type IV. The follow-up period was up to 120 months. The long-term results of patients were assessed. An increase and preservation of LV contractility was revealed, despite the reverse LV remodeling in the long-term period (p=0.01). According to the univariate Cox regression analysis, it was revealed that MV plastic surgery reduces the likelihood of fatal outcome in the long-term period (HR=0.306, p=0.027). Conclusions . 1. Combined correction of anterior and posterior aneurysms is not associated with perioperative risk of death. 2. Combined correction of anterior and posterior aneurysms is accompanied by a significant increase and preservation of LV contractility both in the early and late follow-up periods. 3. MV plastic surgery reduces the likelihood of death in the late period (HR=0.306, p=0.027).