PDF(Pubmed)
Abstract：
Ischemic cardiomyopathy patients with severe left ventricular dysfunction are a specific group of patients with poor surgical outcomes. There are few surgical treatment options in practice for the treatment of these patients such as heart transplantation, coronary artery bypass surgery, surgical ventricular restoration, etc. Despite multiple treatment options, there are no explicit clinical guidelines available to guide surgeons in choosing the most appropriate option and ensuring that the specific patient can benefit from the selected surgical treatment. Heart transplantation is the gold standard treatment for ischemic cardiomyopathy patients with severe left ventricular dysfunction, but it is limited to very few highly equipped centers around the world due to donor shortages, complex perioperative and surgical management, and limited technological and human resources. It is evident from some studies that heart transplant-eligible candidates can benefit from alternative surgical options such as coronary artery bypass surgery alone or combined with surgical ventricular restoration. Therefore, alternative surgical options that are used for most of the population, especially in developing and underdeveloped countries, need to be discussed to improve their outcomes. A challenge in the recent era which has yet to find a solution is to determine which heart transplant candidate can benefit from simple revascularization compared to a complex heart transplantation procedure. Myocardial viability testing was one of the most important determinants in deciding whether a patient should undergo revascularization, but its role in guiding appropriate surgical options has been challenged. This review aims to discuss the available surgical management options and their long-term outcomes for patients with ischemic cardiomyopathy, which will eventually help surgeons when choosing a surgical procedure.
摘要：
具有严重左心功能不全的缺血性心肌病患者是手术效果较差的特定患者组。在实践中很少有手术治疗这些患者的选择，例如心脏移植，冠状动脉搭桥手术,外科心室恢复，等。尽管有多种治疗选择,目前尚无明确的临床指南来指导外科医生选择最合适的方案,并确保特定患者能够从选定的手术治疗中获益.心脏移植是缺血性心肌病伴严重左心功能不全患者治疗的金标准,但由于捐助者短缺，它仅限于世界上很少有设备齐全的中心，复杂的围手术期和手术管理，有限的技术和人力资源。从一些研究中可以明显看出，符合心脏移植资格的候选人可以从替代手术选择中受益，例如单独进行冠状动脉搭桥手术或与手术心室恢复相结合。因此,用于大多数人口的替代手术选择，特别是在发展中国家和不发达国家，需要讨论以改善他们的结果。在最近的时代，尚未找到解决方案的挑战是确定与复杂的心脏移植程序相比，哪种心脏移植候选者可以从简单的血运重建中受益。心肌活力测试是决定患者是否应该进行血运重建的最重要的决定因素之一。但其在指导适当手术选择方面的作用受到了挑战。这篇综述旨在讨论缺血性心肌病患者可用的手术治疗方案及其长期预后。这将最终帮助外科医生选择外科手术。
