Article Abstract

Surgical ventricular reconstruction for ischemic cardiomyopathy—a systematic review and meta-analysis of 7,685 patients

Brandon E. Ferrell, Diana C. Jimenez, Danial Ahmad, Kabir Malkani, Jake L. Rosen, Gabriel Gaw, Konstadinos A. Plestis, T. Sloane Guy, H. Todd Massey, Vakhtang Tchantchaleishvili

Abstract

Background: 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.
Methods: 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.
Results: 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 vs. post-SVR, significant improvement was seen in left ventricular ejection fraction (LVEF) [29.9% (28.8–31.2%) vs. 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) vs. 45 mm (42.8–47.3), P<0.01, LVEDD: 63.8 mm (62–65.6) vs. 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/m2 (79.3–88.4) vs. 46.8 mL/m2 (43.5–50.1), P<0.01; LVEDVI: 119.9 mL/m2 (112.1–127.6) vs. 79.6 mL/m2 (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.
Conclusions: In patients with ischemic cardiomyopathy, SVR reduces left ventricular volumes and improves systolic function leading to symptomatic improvement.