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Surgical ventricular restoration: where do we go from here?
Constantine L Athanasuleas1, Gerald Buckberg
1Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA, cathanasuleas@uab.edu.
Heart Failure Reviews
|May 17, 2014
Summary
Surgical ventricular restoration (SVR) combined with bypass grafting did not improve survival in ischemic heart failure patients per the STICH trial. Discrepancies with observational data suggest trial conduct may have influenced outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Failure Research
Background:
- The Surgical Treatment for Ischemic Heart Failure (STICH) trial reported no survival benefit from adding surgical ventricular restoration (SVR) to coronary bypass grafting (CABG) in dilated ischemic cardiomyopathy.
- Contrasting observational studies show significant long-term survival (approx. 70%) and improved ventricular function with SVR.
- Discrepancies between trial and observational data warrant further investigation into trial methodology.
Purpose of the Study:
- To review the causes for the discrepancy between STICH trial results and observational data on surgical ventricular restoration (SVR) for ischemic heart failure.
- To identify potential patient subgroups who might benefit from SVR based on a re-analysis of STICH trial data.
- To address confounding factors in the STICH trial, such as unsuitable patient entry criteria and surgical approaches.
Main Methods:
- Review of existing literature comparing STICH trial outcomes with observational studies on SVR.
- Analysis of recent STICH subset data relating ventricular volumes to patient outcomes.
- Proposal for re-analyzing STICH data according to its original design parameters.
Main Results:
- The STICH trial did not demonstrate improved survival with SVR plus CABG for ischemic cardiomyopathy.
- Observational studies consistently report positive outcomes, including improved global ventricular function and high long-term survival rates with SVR.
- Potential confounding factors in the STICH trial include patient selection and surgical execution.
Conclusions:
- The methodology and patient selection in the STICH trial may have obscured the potential benefits of SVR in specific patient populations.
- Re-analysis of STICH data, focusing on the initial trial design, is recommended to identify patients who could benefit from SVR.
- Further research is needed to reconcile the conflicting findings and optimize SVR application in ischemic heart failure management.
