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

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Michler, RE; Rouleau, JL; Al-Khalidi, HR; Bonow, RO; Pellikka, PA; Pohost, GM; Holly, TA; Oh, JK; Dagenais, F; Milano, C; Wrobel, K; Pirk, J; Ali, IS; Jones, RH; Velazquez, EJ; Lee, KL; Di Donato, M; STICH Trial Investigators,

Published Date

  • November 2013

Published In

Volume / Issue

  • 146 / 5

Start / End Page

  • 1139 - 1145.e6

PubMed ID

  • 23111018

Pubmed Central ID

  • 23111018

Electronic International Standard Serial Number (EISSN)

  • 1097-685X

Digital Object Identifier (DOI)

  • 10.1016/j.jtcvs.2012.09.007

Language

  • eng

Conference Location

  • United States