Castelvecchio Serenella, Garatti Andrea, Gagliardotto Pier Vincenzo, Menicanti Lorenzo
Department Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy.
Eur Heart J Suppl. 2016 Apr 28;18(Suppl E):E8-E14. doi: 10.1093/eurheartj/suw028. Epub 2016 Apr 29.
Patients with ischaemic cardiomyopathy and left ventricular (LV) systolic dysfunction represent the highest-risk population with heart failure (HF). The cornerstone of treatment remains guideline-driven medical therapy, which is associated with significant improvement in survival and quality of life. The most commonly considered surgical interventions are coronary artery bypass graft surgery, at times combined with surgical ventricular reconstruction (SVR) and surgery for mitral valve regurgitation. Surgical ventricular reconstruction has been introduced as an optional therapeutic strategy aimed to reduce LV volumes through the exclusion of the scar tissue, thereby restoring the physiological volume and shape and improving cardiac function and clinical status. This review will briefly discuss the rationale to surgically reverse LV remodelling, the technique, and the indications, to the best of our knowledge, coming from the Center with the largest worldwide experience. The evolving data on the role of SVR for the treatment of ischaemic HF will be addressed as well.
缺血性心肌病和左心室（LV）收缩功能障碍患者是心力衰竭（HF）风险最高的人群。治疗的基石仍然是遵循指南的药物治疗，这与生存率和生活质量的显著改善相关。最常考虑的外科干预措施是冠状动脉旁路移植术，有时结合外科心室重建（SVR）和二尖瓣反流手术。外科心室重建作为一种可选的治疗策略被引入，旨在通过排除瘢痕组织来减少左心室容积，从而恢复生理容积和形状，改善心脏功能和临床状况。本综述将简要讨论通过手术逆转左心室重构的基本原理及其技术和适应症，据我们所知，这些内容来自全球经验最丰富的中心。同时也将探讨SVR在治疗缺血性心力衰竭中作用的最新数据。
