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

Abstract

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.