Classic Repair (Linear repair) : The operation is done under cardio pulmonary bypass, through median sternotomy. If additional CABG is required, conduit harvesting is done. The left ventricle should not be disturbed till the heart is arrested on cardio pulmonary bypass, to reduce the chances of embolisation of LV clot. Antegrade and retrograde cardioplegia are used. Bicaval cannulation and snaring of cavae is the
preferred technique. Aneurysm is incised and opened vertically and all clots are removed. The thinned out portion of the aneurysm is removed leaving small margins where the normal muscle and the thinned out portions meet. LV cavity is irrigated with saline. Sutures are placed at the upper and lower ends of vertical ventliculotomy. Two strips of PTFE (poly tetrafluoro ethylene) felts are cut, the length depending on the final shape of the LV that is to be achieved. 2'0' polyester, double armed mattress sutures are passed incorporating both teflon felt ships and medial as well as lateral margins of opened LV After passing mattress sutures through the entire length of repair, they are tied. The lowest one near the apex is tied after filling LV and removing all air. Two layers of continuous polypropylene sutures are used to reinforce the previous mattress sutures.
Thorough deairing of he left heart and aortic root has to be done before it is allowed to beat.
If coronary artery bypass grafts have to be done, distal anastomoses are done before the repair of aneurysm. The proximal anastomoses arc done at the end after the release of aortic cross clamp.