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Published on: March 27, 2018
Coronary Artery Bypass Grafting With or Without Concomitant Surgical Ventricular Reconstruction in Ischemic
Jianbo Liao1, Zhuoming Zhou2,3, Yi Zhang1
1Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, China.
Insights
Surgical ventricular reconstruction plus coronary artery bypass grafting (SVR+CABG) improves long-term survival and cardiac function in ischemic cardiomyopathy patients compared to CABG alone. This combined approach offers significant benefits for heart failure management.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Heart Failure Research
Background:
- Ischemic cardiomyopathy (ICM) significantly impairs left ventricular function.
- Coronary artery bypass grafting (CABG) is a standard treatment for ICM.
- Surgical ventricular reconstruction (SVR) aims to remodel the left ventricle.
Purpose of the Study:
- To compare long-term outcomes of SVR combined with CABG (SVR+CABG) versus CABG alone in patients with ICM.
- To evaluate the impact on mortality, rehospitalization, and cardiac function indicators.
Main Methods:
- Systematic literature search of major databases (PubMed, Embase, Scopus, Cochrane, Web of Science) until November 2024.
- Inclusion of studies comparing SVR+CABG and CABG in ICM patients (LVEF < 40%).
- Primary outcome: long-term mortality; Secondary outcomes: hospital mortality, rehospitalization, cardiac function.
Main Results:
- Twelve studies (3188 patients) analyzed: 1629 in SVR+CABG, 1559 in CABG.
- SVR+CABG demonstrated higher survival rates (HR 0.82) and significant reduction in left ventricular end-systolic volume index (ESVI).
- Dor surgery subgroup showed additional survival benefits (HR 0.83) compared to CABG alone.
Conclusions:
- SVR+CABG is associated with superior long-term survival compared to CABG alone in ICM patients.
- The combined approach leads to a more significant reduction in ESVI and fewer cardiac rehospitalizations.
- SVR+CABG improves overall cardiac function and patient outcomes, including New York Heart Association class.
Purpose:
The present study aims to compare the long-term outcomes of surgical ventricular reconstruction (SVR) combined with coronary artery bypass grafting (CABG) versus CABG alone in patients with ischemic cardiomyopathy (ICM).
Methods:
A systematic literature search was conducted in PubMed, Embase, Scopus, Cochrane Library, and Web of Science until November 2024. Studies comparing SVR + CABG and CABG in patients with ischemic cardiomyopathy (left ventricular ejection fraction less than 40%) were included. The primary outcome included long-term mortality, and the secondary outcomes included hospital mortality, rehospitalization for cardiac causes, and other cardiac function indicators.
Results:
Twelve studies with a total of 3188 patients were included, with 1629 undergoing SVR + CABG and 1559 undergoing CABG. Patients who underwent SVR + CABG had a higher survival rate (HR 0.82; 95% CI, 0.69-0.96; I2 = 4%; P = 0.01) and a more significant postoperative left ventricular end-systolic volume index (ESVI) reduction (MD 15.53; 95% CI, 6.41-24.65; I2 = 93%; P = 0.01). In the subgroup analysis, the Dor (endoventricular circular patch plasty) surgery provided additional survival benefits compared with CABG (HR 0.83; 95% CI, 0.70-0.97; I2 = 9%; P = 0.02). The reconstructed Kaplan-Meier curves show that the survival rates in the SVR + CABG, Dor, Non-Dor, Mannequin-free, Mannequin, and CABG groups were 81.13%, 82.02%, 76.38%, 83.23%, 69.40%, and 71.42% at 60 months, respectively.
Conclusions:
Compared with CABG, SVR + CABG is associated with higher survival, a more significant reduction in ESVI, fewer rehospitalizations for cardiac causes, and more patients gaining postoperative New York Heart Association class improvement.
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