Masroor Matiullah, Wang Yixuan, Zhang Chao, Dong Nianguo
Department of Cardiovascular Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Qargha Rd, Kabul 1010, Afghanistan.
J Cardiovasc Dev Dis. 2024 Jun 21;11(7):184. doi: 10.3390/jcdd11070184.
Ischemic cardiomyopathy patients with severe left ventricular dysfunction are a specific group of patients with poor surgical outcomes. There are few surgical treatment options in practice for the treatment of these patients such as heart transplantation, coronary artery bypass surgery, surgical ventricular restoration, etc. Despite multiple treatment options, there are no explicit clinical guidelines available to guide surgeons in choosing the most appropriate option and ensuring that the specific patient can benefit from the selected surgical treatment. Heart transplantation is the gold standard treatment for ischemic cardiomyopathy patients with severe left ventricular dysfunction, but it is limited to very few highly equipped centers around the world due to donor shortages, complex perioperative and surgical management, and limited technological and human resources. It is evident from some studies that heart transplant-eligible candidates can benefit from alternative surgical options such as coronary artery bypass surgery alone or combined with surgical ventricular restoration. Therefore, alternative surgical options that are used for most of the population, especially in developing and underdeveloped countries, need to be discussed to improve their outcomes. A challenge in the recent era which has yet to find a solution is to determine which heart transplant candidate can benefit from simple revascularization compared to a complex heart transplantation procedure. Myocardial viability testing was one of the most important determinants in deciding whether a patient should undergo revascularization, but its role in guiding appropriate surgical options has been challenged. This review aims to discuss the available surgical management options and their long-term outcomes for patients with ischemic cardiomyopathy, which will eventually help surgeons when choosing a surgical procedure.
重度左心室功能障碍的缺血性心肌病患者是手术预后较差的特定患者群体。在实际治疗中，针对这类患者的手术治疗选择较少，如心脏移植、冠状动脉搭桥手术、手术性心室修复等。尽管有多种治疗选择，但目前尚无明确的临床指南来指导外科医生选择最合适的方案，并确保特定患者能从所选的手术治疗中获益。心脏移植是重度左心室功能障碍的缺血性心肌病患者的金标准治疗方法，但由于供体短缺、围手术期和手术管理复杂以及技术和人力资源有限，全球仅有极少数设备精良的中心能够开展。一些研究表明，符合心脏移植条件的患者可从替代手术选择中获益，如单纯冠状动脉搭桥手术或联合手术性心室修复。因此，需要讨论适用于大多数人群，尤其是发展中国家和不发达国家的替代手术选择，以改善其治疗效果。近期尚未找到解决方案的一个挑战是，确定与复杂的心脏移植手术相比，哪些心脏移植候选者能从简单的血运重建中获益。心肌存活检测是决定患者是否应接受血运重建的最重要决定因素之一，但其在指导合适的手术选择方面的作用受到了挑战。本综述旨在讨论缺血性心肌病患者可用的手术管理选择及其长期疗效，这最终将有助于外科医生选择手术方式。
