Castelvecchio Serenella, Milani Valentina, Ambrogi Federico, Volpe Marianna, Ramputi Lucia, Soletti Giovanni, Menicanti Lorenzo
Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Italy.
Laboratory of Biostatistics and Data Management, Scientific Directorate, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Italy.
J Pers Med. 2022 Apr 2;12(4):567. doi: 10.3390/jpm12040567.
Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic strategy for ischemic heart failure (HF) patients, although the survival benefit is still debated. We investigated a real-world population treated with SVR in a single center with high case volumes. From July 2001 to June 2017, 648 patients (111 females) underwent SVR; coronary surgery was performed in 582 patients. Data were analyzed by dividing the population into two groups: Group I (371 patients operated between July 2001 and December 2007) and Group II (277 patients operated between January 2008 and June 2017). At baseline, Group I patients were more symptomatic for angina (47.4% versus 19.4%, p < 0.0001) and less symptomatic for HF (NYHA class III/IV, 46.3% versus 57%, p = 0.0071). The end-diastolic volume (106 mL/m2 versus 118.3 mL/m2, p < 0.0001) and the end-systolic volume (70.5 mL/m2 versus 81.5 mL/m2, p < 0.0001) were lower in Group I. The presence of 3-vessel coronary artery disease (CAD) was higher in Group I (73.3% versus 59.2%, p < 0.0001). Thirty-day mortality (6.64%) was similar in the two groups (p = 0.4475). The Kaplan−Meier estimate for all-cause mortality for the entire population was 13% at 2 years, 19.2% at 4 years and 36.6% at 8 years, and the probability was not different between groups (Log-rank = 0.11). In a real-world ischemic HF population, SVR may be carried out with favorable results; in patients with worse LV remodeling and less extensive CAD, SVR showed a trend toward a better outcome.
外科心室修复术（SVR）一再被认为是缺血性心力衰竭（HF）患者可行的治疗策略，尽管其生存获益仍存在争议。我们调查了在一个高病例数的单中心接受SVR治疗的真实世界人群。2001年7月至2017年6月，648例患者（111例女性）接受了SVR；582例患者接受了冠状动脉手术。通过将人群分为两组进行数据分析：第一组（2001年7月至2007年12月手术的371例患者）和第二组（2008年1月至2017年6月手术的277例患者）。基线时，第一组患者心绞痛症状更明显（47.4%对19.4%，p<0.0001），HF症状较轻（纽约心脏协会III/IV级，46.3%对57%，p = 0.0071）。第一组的舒张末期容积（106 mL/m²对118.3 mL/m²，p<0.0001）和收缩末期容积（70.5 mL/m²对81.5 mL/m²，p<0.0001）较低。第一组三支冠状动脉疾病（CAD）的发生率更高（73.3%对59.2%，p<0.0001）。两组的30天死亡率（6.64%）相似（p = 0.4475）。整个人群全因死亡率的Kaplan-Meier估计值在2年时为13%，4年时为19.2%，8年时为36.6%，两组之间的概率无差异（对数秩检验=0.11）。在真实世界的缺血性HF人群中，SVR可以取得良好的效果；在左心室重构较差且CAD范围较小的患者中，SVR显示出更好结局的趋势。
