PDF(Pubmed)
Abstract：
BACKGROUND: Ischemic cardiomyopathy (ICM) accounts for more than 60% of congestive heart failure cases and is associated with high morbidity and mortality rates. Myocardial revascularization in patients with left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) ≤35% aims to improve survival and quality of life and reduce complications associated with heart failure and coronary artery disease. The majority of randomized clinical trials have consistently excluded those patients, resulting in evidence primarily derived from observational studies.
METHODS: We performed a scoping review using the Arksey and O\'Malley methodology in five stages: 1) formulating the research question; 2) locating relevant studies; 3) choosing studies; 4) organizing and extracting data; and 5) compiling, summarizing, and presenting the findings. This literature review covers primary studies and systematic reviews focusing on surgical revascularization strategies in adult patients with ischemic left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) of 35% or lower. Through an extensive search of Medline and the Cochrane Library, a systematic review was conducted to address three questions regarding myocardial revascularization in these patients. These questions outline the current knowledge on this topic, current surgical strategies (off-pump vs. on-pump), and graft options (including hybrid techniques) utilized for revascularization. Three independent reviewers (MAE, DP, and AM) applied the inclusion criteria to all the included studies, obtaining the full texts of the most relevant studies. The reviewers subsequently assessed these articles to make the final decision on their inclusion in the review. Out of the initial 385 references, 156 were chosen for a detailed review. After examining the full articles were examined, 134 were found suitable for scoping review.
CONCLUSIONS: The literature notes the scarcity of surgical revascularization in LVD patients in randomized studies, with observational data supporting coronary revascularization\'s benefits. ONCABG is recommended for multivessel disease in LVD with LVEF < 35%, while OPCAB is proposed for older, high-risk patients. Strategies like internal thoracic artery skeletonization harvesting and postoperative glycemic control mitigate risks with BITA in uncontrolled diabetes. Total arterial revascularization maximizes long-term survival, and hybrid revascularization offers advantages like shorter hospital stays and reduced costs for significant LAD lesions.
METHODS: We performed a scoping review using the Arksey and O\'Malley methodology in five stages: 1) formulating the research question; 2) locating relevant studies; 3) choosing studies; 4) organizing and extracting data; and 5) compiling, summarizing, and presenting the findings. This literature review covers primary studies and systematic reviews focusing on surgical revascularization strategies in adult patients with ischemic left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF) of 35% or lower. Through an extensive search of Medline and the Cochrane Library, a systematic review was conducted to address three questions regarding myocardial revascularization in these patients. These questions outline the current knowledge on this topic, current surgical strategies (off-pump vs. on-pump), and graft options (including hybrid techniques) utilized for revascularization. Three independent reviewers (MAE, DP, and AM) applied the inclusion criteria to all the included studies, obtaining the full texts of the most relevant studies. The reviewers subsequently assessed these articles to make the final decision on their inclusion in the review. Out of the initial 385 references, 156 were chosen for a detailed review. After examining the full articles were examined, 134 were found suitable for scoping review.
CONCLUSIONS: The literature notes the scarcity of surgical revascularization in LVD patients in randomized studies, with observational data supporting coronary revascularization\'s benefits. ONCABG is recommended for multivessel disease in LVD with LVEF < 35%, while OPCAB is proposed for older, high-risk patients. Strategies like internal thoracic artery skeletonization harvesting and postoperative glycemic control mitigate risks with BITA in uncontrolled diabetes. Total arterial revascularization maximizes long-term survival, and hybrid revascularization offers advantages like shorter hospital stays and reduced costs for significant LAD lesions.
摘要：
背景：缺血性心肌病（ICM）占充血性心力衰竭病例的60％以上，并与高发病率和死亡率相关。左心室功能障碍（LVD）且左心室射血分数（LVEF）≤35％的患者的心肌血运重建旨在提高生存率和生活质量，并减少与心力衰竭和冠状动脉疾病相关的并发症。大多数随机临床试验一致排除了这些患者，产生的证据主要来自观察性研究。
方法：我们使用Arksey和O\'Malley方法分五个阶段进行了范围审查：1）制定研究问题；2）定位相关研究；3）选择研究；4）组织和提取数据；5）汇编，总结,并介绍调查结果。本文献综述涵盖了主要研究和系统评价，重点是缺血性左心室功能障碍（LVD）和左心室射血分数（LVEF）为35％或更低的成年患者的手术血运重建策略。通过对Medline和Cochrane图书馆的广泛搜索，我们进行了系统评价,以解决有关这些患者的心肌血运重建的三个问题.这些问题概述了当前关于这个主题的知识，当前的手术策略(非体外循环与on-pump),和用于血运重建的移植物选择（包括混合技术）。三名独立审稿人(MAE，DP,和AM)将纳入标准应用于所有纳入的研究，获取最相关研究的全文。审稿人随后对这些文章进行了评估，以便就将其纳入审查做出最终决定。在最初的385个参考文献中，156人被选中进行详细的审查。在检查了全文之后，134人被发现适合范围审查。
结论：文献指出，在随机研究中，LVD患者手术血运重建的稀缺性，观察数据支持冠状动脉血运重建的益处。建议将ONCABG用于LVEF<35％的LVD多支血管病变，虽然OPCAB是为老年人提议的，高危患者。胸廓内动脉骨骼化收集和术后血糖控制等策略可降低BITA在未控制的糖尿病中的风险。全动脉血运重建可最大限度地提高长期生存率，和混合血运重建具有缩短住院时间和降低显著LAD病变成本的优势.
方法：我们使用Arksey和O\'Malley方法分五个阶段进行了范围审查：1）制定研究问题；2）定位相关研究；3）选择研究；4）组织和提取数据；5）汇编，总结,并介绍调查结果。本文献综述涵盖了主要研究和系统评价，重点是缺血性左心室功能障碍（LVD）和左心室射血分数（LVEF）为35％或更低的成年患者的手术血运重建策略。通过对Medline和Cochrane图书馆的广泛搜索，我们进行了系统评价,以解决有关这些患者的心肌血运重建的三个问题.这些问题概述了当前关于这个主题的知识，当前的手术策略(非体外循环与on-pump),和用于血运重建的移植物选择（包括混合技术）。三名独立审稿人(MAE，DP,和AM)将纳入标准应用于所有纳入的研究，获取最相关研究的全文。审稿人随后对这些文章进行了评估，以便就将其纳入审查做出最终决定。在最初的385个参考文献中，156人被选中进行详细的审查。在检查了全文之后，134人被发现适合范围审查。
结论：文献指出，在随机研究中，LVD患者手术血运重建的稀缺性，观察数据支持冠状动脉血运重建的益处。建议将ONCABG用于LVEF<35％的LVD多支血管病变，虽然OPCAB是为老年人提议的，高危患者。胸廓内动脉骨骼化收集和术后血糖控制等策略可降低BITA在未控制的糖尿病中的风险。全动脉血运重建可最大限度地提高长期生存率，和混合血运重建具有缩短住院时间和降低显著LAD病变成本的优势.
