Meta-analysis of mid-term survival and clinical results of left ventricular surgical reconstruction

Relevance. Post-infarction aneurysm of the left ventricle significantly reduces the length and quality of life of patients. The results of comparisons of different methods for surgical restoration of the left ventricle are ambiguous and often contradictory, complicating the choice of an effective treatment strategy and the ability to objectively assess the survival prospects of such patients. The aim of the meta-analysis is to assess the one-year survival of patients after surgical reconstruction of the left ventricle, to determine the functional class of heart failure, and to study the morphological and functional characteristics of the heart. A comparative analysis of the results of the meta-analytic assessment of patient survival after left ventricle reconstruction using the DOR (SAVER) method will be performed in comparison with other treatment methods. Materials and Methods. As a result of a systematic search in two specialized databases (PubMed, Google Scholar), 1,875 articles were selected. A total of 15 studies were included in the final analysis. The total number of patients in these studies was 1,089. To objectify the assessment of the effectiveness of different surgical approaches, two patient groups were formed. The first group underwent only surgical reconstruction of the left ventricle using the Dor procedure or surgical anterior ventricular endocardial restoration (SAVER); the second group received other methods of surgical ventricular reconstruction, depending on the surgical feasibility. Results. The mean age of the examined patients was 62.1 (95% CI: 60.2-64.1) years. The study included 56% (95% CI: 42-69) men. Anterior aneurysm occurred in 87% (95% CI: 74-99) of patients. The mean EuroSCORE value corresponded to 9.7% (95% CI: 7.3-12.1). Before the operation, the patients had a high functional class of heart failure according to NYHA [3 functional class (95% CI: 2.82-3.1)], low left ventricular ejection fraction [31.3% (95% CI: 29.2-33.3)], dilation of the heart chambers [EDVI - 131.7 mL/m2 (95% CI: 113.1-150.2)]. Meta-analysis of the difference in mean values of ejection fraction in patients before and 1 year after surgery showed an increase of 10.1% (95% CI: 8.01-12.1, p 0.001). Meta-analysis of the difference in mean values of EDVI and NYHA functional class of heart failure in patients before and 1 year after surgery showed a decrease of 38.8 ml/m2 (95% CI: 28.1-49.6, p 0.001) and 1.52 (95% CI: 1.3-1.8, p 0.001), respectively. Conclusion. The meta-analysis showed that one year after surgery, survival rates are 94%, with statistically significant increases in ejection fraction and decreases in functional class of heart failure according to the NYHA scale. The studies did not reveal significant differences in patient survival and clinical outcomes one year after operations performed using different surgical methods. The results indicate the effectiveness of left ventricular surgical reconstruction, providing prolonged improvement in patients’ functional status. However, it should be noted that there was significant heterogeneity among the studies.