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Role of surgical ventricular restoration post surgical treatment of heart failure (STICH) trial
Anjith Prakash Rajakumar1, Mithun Sundararaaja Ravikumar1, Vijayanand Palanisamy1
1Department of Cardiac Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, 4A, Dr. J.J. Nagar, Mogappair, Chennai, Tamil Nadu 600037 India.
Insights
Surgical ventricular restoration (SVR) with coronary artery bypass grafting (CABG) shows equivalent late mortality but better left ventricular remodeling and freedom from major adverse cardiac or cerebrovascular events (MACCE) compared to isolated CABG in ischemic cardiomyopathy patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Heart Failure Management
Background:
- Ischemic cardiomyopathy (ICM) with severe left ventricular (LV) dysfunction affects patient prognosis.
- Surgical options for ICM include isolated coronary artery bypass grafting (CABG) and surgical ventricular restoration (SVR), with or without CABG.
Purpose of the Study:
- To compare the clinical and echocardiographic outcomes of SVR (with or without CABG) versus isolated CABG in patients with ICM.
- To evaluate differences in mortality, MACCE, and LV reverse remodeling between the two surgical approaches.
Main Methods:
- Retrospective comparison of 49 patients undergoing SVR (with or without CABG) and 49 patients undergoing isolated CABG for ICM.
- Patients were matched for key preoperative clinical and echocardiographic parameters.
- Primary outcomes included early/late mortality and MACCE; secondary outcomes included LV volumes (LVEDVi, LVESVi) and LVEF.
Main Results:
- No significant difference in LVEF improvement between SVR and CABG groups at 3-month or last follow-up.
- Statistically significant differences favoring SVR were observed in LV end-diastolic and end-systolic volumes at both follow-up points.
- 5-year survival rates were similar (85% SVR vs. 82% CABG), but freedom from MACCE was significantly higher in the SVR group (75% vs. 60%).
Conclusions:
- SVR combined with CABG offers comparable late mortality to isolated CABG in ICM patients.
- SVR demonstrates superior left ventricular reverse remodeling, evidenced by significant LV volume reduction.
- SVR plus CABG leads to improved freedom from MACCE at 5-year follow-up compared to isolated CABG.
Objective:
To compare the outcomes of isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) with or without CABG for patients with ischemic cardiomyopathy (ICM).
Methods:
Retrospectively, 49 patients with ICM and severe LV dysfunction (LVEF < 35%) who underwent SVR with or without CABG from January 2009 to December 2016 at a single institution was compared with 49 patients who underwent isolated CABG. The two groups were matched for preoperative clinical and echocardiographic parameters including left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV). Primary outcomes analyzed included early mortality, late mortality, and major adverse cardiac or cerebrovascular events (MACCE). Secondary outcomes analyzed included echocardiographic parameters of left ventricular volume and function-indexed left ventricular end-diastolic volume (LVEDVi), indexed left ventricular end-systolic volume (LVESVi), and LVEF. Cox and survival analysis was performed.
Results:
Early and late mortality in SVR vs. CABG groups were 4 (8.1%) and 6 (12.2%) vs. 1 (2%) and 5 (10.2%) respectively. Mean improvement in LVEF was 3.39 ± 7.51 compared to 4.97 ± 5.45 between the two groups at 3-month follow-up. Mean improvement in LVEF was 5.1 ± 8.3 in the SVR group vs 5.9 ± 7.1 in the CABG group at the last follow-up. There was no statistically significant improvement between the two groups in terms of LVEF at 3 months or the last follow-up. There were statistically significant differences between LVEDVi and LVESVi between the two groups at 3 months and the last follow-up. The 5-year rates of survival were 85 ± 6 and 82 ± 9% for SVR and CABG groups respectively. The 5-year rates of freedom from MACCE were 75 ± 7 and 60 ± 11% for SVR and CABG groups respectively.
Conclusion:
Compared with isolated CABG, SVR plus CABG results in equivalent late mortality and better left ventricular reverse remodeling (as evidenced by LV volume reduction) and better freedom from MACCE at 5-year follow-up.
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