Ferrell Brandon E, Jimenez Diana C, Ahmad Danial, Malkani Kabir, Rosen Jake L, Gaw Gabriel, Plestis Konstadinos A, Guy T Sloane, Massey H Todd, Tchantchaleishvili Vakhtang
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY, USA.
Ann Cardiothorac Surg. 2022 May;11(3):226-238. doi: 10.21037/acs-2021-ami-17.
Surgical ventricular reconstruction (SVR) has been used to control adverse ventricular remodeling and improve cardiac function in ischemic cardiomyopathy. The purpose of this systematic review and meta-analysis was to collect and analyze all available evidence on the utilization and efficacy of SVR.
An electronic database search was performed to identify all retrospective and prospective studies on SVR for ischemic cardiomyopathy in the English literature from 2000 through 2020. A total of 92 articles with a collective 7,685 patients undergoing SVR were included in the final analysis.
The mean patient age was 61 years (95% CI: 59-63) and 80% (78-82%) were male. Congestive heart failure was present in 66% (54-78%) and angina in 58% (45-70%). Concomitant coronary artery bypass grafting was undertaken in 92% (90-93%) while 21% (18-24%) underwent mitral valve repair. Pre post-SVR, significant improvement was seen in left ventricular ejection fraction (LVEF) [29.9% (28.8-31.2%) 40.9% (39.4-42.4%), P<0.01], left ventricular end-systolic (LVESD) and end-diastolic diameters (LVEDD) [LVESD: 49.9 mm (48.1-51.7) 45 mm (42.8-47.3), P<0.01, LVEDD: 63.8 mm (62-65.6) 58.23 mm (56.6-60), P<0.01], and left ventricular end-systolic (LVESVI) and end-diastolic volume indices (LVEDVI) [LVESVI: 83.9 mL/m (79.3-88.4) 46.8 mL/m (43.5-50.1), P<0.01; LVEDVI: 119.9 mL/m (112.1-127.6) 79.6 mL/m (73.6-85.7), P<0.01]. Mean New York Heart Association class improved from 3 (2.8-3.1) to 1.8 (1.5-2) (P<0.01). The 30-day mortality was 4% (3-5%) while late mortality was 19% (9-34%) at a mean follow-up of 27.5 [21-34] months.
In patients with ischemic cardiomyopathy, SVR reduces left ventricular volumes and improves systolic function leading to symptomatic improvement.
手术性心室重建（SVR）已被用于控制缺血性心肌病患者的不良心室重构并改善心脏功能。本系统评价和荟萃分析的目的是收集和分析关于SVR应用及疗效的所有现有证据。
进行电子数据库检索，以识别2000年至2020年英文文献中所有关于缺血性心肌病SVR的回顾性和前瞻性研究。最终分析纳入了92篇文章，共7685例接受SVR的患者。
患者平均年龄为61岁（95%可信区间：59 - 63），80%（78 - 82%）为男性。66%（54 - 78%）存在充血性心力衰竭，58%（45 - 70%）有胸痛症状。92%（90 - 93%）的患者同期进行了冠状动脉旁路移植术，21%（18 - 24%）进行了二尖瓣修复。SVR前后，左心室射血分数（LVEF）有显著改善[29.9%（28.8 - 31.2%）升至40.9%（39.4 - 42.4%），P<0.01]，左心室收缩末期内径（LVESD）和舒张末期内径（LVEDD）也有改善[LVESD：49.9 mm（48.1 - 51.7）降至45 mm（42.8 - 47.3），P<0.01，LVEDD：63.8 mm（62 - 65.6）降至58.23 mm（56.6 - 60），P<0.01]，左心室收缩末期容积指数（LVESVI）和舒张末期容积指数（LVEDVI）同样如此[LVESVI：83.9 mL/m（79.3 - 88.4）降至46.8 mL/m（43.5 - 50.1），P<0.01；LVEDVI：119.9 mL/m（112.1 - 127.6）降至79.6 mL/m（73.6 - 85.7），P<0.01]。纽约心脏协会心功能分级平均从3（2.8 - 3.1）改善至1.8（
