Surgical left ventricle reconstruction, pathophysiologic insights, results and expectation from the STICH trial

Post-infarction ischemic cardiomyopathy is the most frequent cause of clinical heart failure in the western society. Despite aggressive early revascularization, myocardial infarction leaves shape and function abnormalities in a consistent number of patients with increased risk of death and ischemic events. Alternative treatment strategies are therefore advisable in these high-risk patients. Surgical ventricular restoration (SVR) is a safe and effective surgical option for post-infarction ischemic cardiomyopathy resulting in improvement of pump function, functional class and survival. Observational data now need to be confirmed by randomized data and the multicenter international randomized surgical treatment of ischemic heart failure (STICH) trial will definitely assess if SVR adds benefit to coronary bypass alone in patients with left ventricular dysfunction and dilated ventricle.