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Purpose <p>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).</p> Methods <p>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.</p> Results <p>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; <i>I</i><sup>2</sup> = 4%; <i>P</i> = 0.01) and a more significant postoperative left ventricular end-systolic volume index (ESVI) reduction (MD 15.53; 95% CI, 6.41–24.65; <i>I</i><sup>2</sup> = 93%; <i>P</i> = 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; <i>I</i><sup>2</sup> = 9%; <i>P</i> = 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&#xa0;months, respectively.</p> Conclusions <p>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.</p> Graphical Abstract <p>We collected data from patients who underwent either SVR+CABG or CABG surgery, and created forest plots and survival curves. Our analysis revealed that SVR+CABG results in better survival rates compared to CABG alone. These findings suggest that adding SVR surgery can provide clinical benefits for patients with ischemic cardiomyopathy, and it can be factored into the designs of future investigations in ischemic cardiomyopathy. Reconstructed survival curves of CABG and SVR+CABG.</p> <p></p>

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Coronary Artery Bypass Grafting With or Without Concomitant Surgical Ventricular Reconstruction in Ischemic Cardiomyopathy Patients

  • 期刊论文

  • 发表日期：

    2025年6月5日

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  • Jianbo Liao,
  • Zhuoming Zhou,
  • Yi Zhang,
  • Zhilin Miao,
  • Gang Li,
  • Hanri Xiao,
  • Qiushi Ren,
  • Bohao Jian,
  • Zhongkai Wu,
  • Mengya Liang

摘要

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.

Graphical Abstract

We collected data from patients who underwent either SVR+CABG or CABG surgery, and created forest plots and survival curves. Our analysis revealed that SVR+CABG results in better survival rates compared to CABG alone. These findings suggest that adding SVR surgery can provide clinical benefits for patients with ischemic cardiomyopathy, and it can be factored into the designs of future investigations in ischemic cardiomyopathy. Reconstructed survival curves of CABG and SVR+CABG.