在左心室功能障碍患者中进行心肌再血管化的当前指示和手术策略:一个范围审查
Alejandro Moreno-Angarita1,2, Diego Peña3, Juan David Lopez-Ponce de León4
1Fundación Valle del Lili - Departamento de Cirugía - Servicio de Cirugía Cardiovascular, Carrera 98 No. 18-49, Cali, Valle del Cauca, 760032, Colombia.
Journal of cardiothoracic surgery
|July 27, 2024
概括
手术复血管化改善了缺血性心肌病和低射出分数患者的结果. 建议在多血管疾病中进行非抽动冠状动脉旁路移植,而全动脉或混合动脉策略提供长期生存益处.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
- 医学研究 医学研究
背景情况:
- 缺血性心肌病 (ICM) 是心力衰竭的主要原因,其特点是患病率和死亡率高.
- 心肌再血管旨在改善左心室功能障碍 (LVD) 和LVEF ≤35%的患者的生存率和生活质量.
- 随机临床试验经常排除这些患者,将证据限制在观察性研究中.
研究的目的:
- 对LVD和LVEF≤35%的成年患者进行外科重血管化策略的范围审查.
- 概述当前的知识,手术技术 (在上与离),以及在这个人群中进行心肌再血管化的移植选择.
主要方法:
- 使用Arksey和O'Malley方法进行了范围审查.
- 在Medline和科克兰图书馆进行了搜索.
- 三位独立审查员评估了156项选定的研究,最终包括134项进行审查.
主要成果:
- 观察数据支持LVD患者冠状动脉复血管化的好处.
- 在冠状动脉旁路移植 (ONCABG) 建议用于LVEF<35%的多血管疾病.
- 建议对老年,高风险的个人进行非抽动冠状动脉旁路移植 (OPCAB).
结论:
- 整体动脉复血管化最大限度地提高了长期生存率.
- 混合再血管化为显著的左前下降 (LAD) 病变提供了好处,包括更短的住院时间和更低的成本.
- 特定的策略可以减轻与糖尿病患者双边内胸动脉 (BITA) 移植相关的风险.
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