Adhyapak SM, Menon PG, Parachuri VR, Michael J, Thomas T. Surgical ventricular restoration-meta-analysis of observational studies.
Indian J Thorac Cardiovasc Surg 2020;
36:347-355. [PMID:
33061142 DOI:
10.1007/s12055-019-00902-2]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/24/2019] [Accepted: 11/07/2019] [Indexed: 11/27/2022] Open
Abstract
Background
Technique of surgical ventricular restoration (SVR) may impact its outcomes. Therefore, we conducted a meta-analysis of studies on SVR performed by using different techniques and studied outcomes.
Methods
Scientific databases were searched for studies on SVR. End points assessed were NYHA class, left ventricular ejection fraction (LVEF), end-systolic volume index (ESVI), sphericity index, apical rotations, mortality, and re-admissions for heart failure.
Results
Circular patch use showed significant increases in LVEF by 9.53% (7.62, 11.45), decreases in ESVI by - 35.16 ml (- 44.97, - 25.34), improvements in NYHA class by - 1.29 (- 1.45, - 1.13), and decreases in sphericity index by - 0.04 (- 0.08, 0.00) . In studies using rectangular patch, the LVEF showed an increase by 5.75% (3.52, 7.98,), the NYHA class improved by - 2.45 (- 2.59, - 2.32). The decrease in ESVI was - 40.36 ml (- 62.2, - 18.52). The apical rotation increased by 3.45 0 (0.62, 6.29,). Re-admission for heart failure and mortality was less.When the magnitude of ESVI decrease were compared within studies using rectangular patch, the greatest decrease in ESVI was notedwith use of a rectangular patch. (- 59 ml versus - 40 ml a very narrow patch and - 22 ml use of oval patch) The improvements in sphericity index at 2 years in use of rectangular patch study was - 0.78 ± 0.11 versus 0.00 ± 0.03 in use of oval patch study.
Conclusions
Rectangular patch use resulted in maximal decreases in ESVI and sphericity index. Mortality and re-admissions for heart failure were also significantly less at mid-term after SVR.
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