The Effect of 30% or More Volume Reduction Achieved by Surgical Ventricular Reconstruction for Ischemic Cardiomyopathy: A Systematic Review

Abstract

Background

Ischemic cardiomyopathy, commonly attributable to coronary artery disease, leads to ventricular remodeling. Surgical ventricular reconstruction (SVR) aims to reverse this by restoring cardiac morphology. This review evaluates SVR's influence on ventricular volume reduction, comparing <30% to >30% reduction effects on left ventricular ejection fraction (LVEF) and patient outcomes.

Methods

A systematic search following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed in PubMed, Embase, Web of Science, and the Cochrane Collaboration. Data extracted included left ventricular end systolic volume, LVEF, New York Heart Association classification, mitral regurgitation grade, and mortality rates.

Results

Of the 37 articles included, 29 reported a mean volume reduction of >30%, while 8 reported a reduction <30%. A total of 4975 participants were included across all studies. Mean volume reduction was 43% in group 1 (>30%) and 28% in group 2 (<30%). The mean relative increase in LVEF for group 1 was 38%, which was larger compared to group 2 with 30%. Additionally, mean reduction in New York Heart Association class was 1.5 in group 1 and 1.2 in group 2. There was no difference in mitral regurgitation grade reduction between the 2 groups. Postoperative mortality within 30 days was 5.8% in group 1 vs. 5.2% in group 2.

Conclusions

Both volume reduction groups showed improved LVEF and outcomes post-SVR, indicating the efficacy of SVR. The majority of studies achieved a volume reduction exceeding 30%, surpassing the 19% reported in the Surgical Treatment for Ischemic Heart Failure trial. Further meta-analysis can determine optimal volume reduction for enhanced cardiac function and outcomes.