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J Thorac Cardiovasc Surg. 2013 Nov;146(5):1139-1145.e6. doi: 10.1016/j.jtcvs.2012.09.007. Epub 2012 Oct 27.

Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction.

Author information

1
Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY. Electronic address: rmichler@montefiore.org.

Abstract

OBJECTIVE:

The present analysis of the Surgical Treatment for Ischemic Heart Failure randomized trial data examined the left ventricular volumes at baseline and 4 months after surgery to determine whether any magnitude of postoperative reduction in end-systolic volume affected survival after coronary artery bypass grafting alone compared with bypass grafting plus surgical ventricular reconstruction.

METHODS:

Of the 1000 patients randomized, 555 underwent an operation and had a paired imaging assessment with the same modality at baseline and 4 months postoperatively. Of the remaining 455 patients, 424 either died before the 4-month study or did not have paired imaging tests and were excluded, and 21 were not considered because they had died before surgery or did not receive surgery.

RESULTS:

Surgical ventricular reconstruction resulted in improved survival compared with coronary artery bypass grafting alone when the postoperative end-systolic volume index was 70 mL/m(2) or less. However, the opposite was true for patients achieving a postoperative volume index greater than 70 mL/m(2). A reduction in the end-systolic volume index of 30% or more compared with baseline was an infrequent event in both treatment groups and did not produce a statistically significant survival benefit with ventricular reconstruction.

CONCLUSIONS:

In patients undergoing coronary artery bypass grafting plus surgical ventricular reconstruction, a survival benefit was realized compared with bypass alone, with the achievement of a postoperative end-systolic volume index of 70 mL/m(2) or less. Extensive ventricular remodeling at baseline might limit the ability of ventricular reconstruction to achieve a sufficient reduction in volume and clinical benefit.

KEYWORDS:

22; 23; CABG; ESVI; LV; STICH; SVR; Surgical Treatment for Ischemic Heart Failure; coronary artery bypass grafting; end-systolic volume index; left ventricular; surgical ventricular reconstruction

PMID:
23111018
PMCID:
PMC3810307
DOI:
10.1016/j.jtcvs.2012.09.007
[Indexed for MEDLINE]
Free PMC Article

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