Results of surgical treatment of chronic heart failure in elderly and senile patients with postinfarction left ventricular aneurysm

The conducted analysis of the results of examination and surgical treatment of elderly and senile patients suffering from post-infarction left ventricular aneurysm (PILVA) and chronic heart failure (CHF) of varying severity is of great scientific interest for further study and application in the practice of gerontology and geriatrics.

BACKGROUND. Chronic heart failure (CHF) is a key medico-social problem in Russia. Its prevalence among individuals over 65 years of age reaches 6–10 %. A significant component of CHF is post-infarction left ventricular aneurysm (PILVA), which occurs in 10 to 35 % of elderly and geriatric patients following myocardial infarction.

Post-infarction remodeling (PIR) processes during aneurysm formation temporarily compensate intracardiac hemodynamics, but only for a very short period. This occurs through the activation of short-term neurohumoral regulation mechanisms, followed by dysfunction of normokinetic myocardial mechanisms, leading to refractory CHF, early disability (within 6 months to 1 year), and high mortality (1 to 3 years) in elderly and geriatric patients receiving solely pharmacological therapy.

Thus, in this context, surgical treatments aimed at restoring normal geometric dimensions of the aneurysmal left ventricle (LV) combined with subsequent myocardial revascularization are the most optimal and play a decisive role in managing CHF in patients over 65 years of age. These patients were previously excluded from all studies addressing this issue.

The implementation of surgical treatments for CHF in patients with PILVA was preceded by a detailed study and evaluation of age-related pathophysiological features of compensatory cardiac mechanisms. This involved patient screening, inclusion/exclusion criteria, determining indications for the extent of surgery (selecting PILVA reconstruction techniques and myocardial revascularization methods), anesthetic management, postoperative care protocols, and assessments of quality of life before surgery, in the early (up to 30 days) and long-term (1 to 5 years) postoperative periods.