Related Experiment Video
Updated: Nov 21, 2025
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Results of surgical ventricular reconstruction in a specialized center and in comparison to the STICH trial:
Mario Gaudino1, Serenella Castelvecchio2, Mohamed Rahouma1
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
Insights
Surgical ventricular reconstruction (SVR) alongside coronary artery bypass grafting (CABG) may improve outcomes in ischemic heart failure patients. This study re-evaluates SVR
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Research
Background:
- Post-infarction left ventricular remodeling increases mortality in ischemic heart disease.
- Surgical ventricular reconstruction (SVR) with coronary artery bypass grafting (CABG) aims to improve outcomes.
- The STICH trial found no significant benefit of SVR plus CABG over CABG alone.
Purpose of the Study:
- To evaluate SVR outcomes in a large single-center series.
- To compare these results with the STICH trial using individual patient data.
- To reassess the efficacy of SVR in ischemic heart failure.
Main Methods:
- Utilizing individual patient data from San Donato University Hospital.
- Employing multivariable Cox regression and propensity score adjustment for analysis.
- Comparing the San Donato cohort with STICH and STICHES trial data.
- Primary endpoint: all-cause mortality.
Main Results:
- This section is to be populated once the study is completed and results are available.
Conclusions:
- This section is to be populated once the study is completed and conclusions are drawn.
Introduction:
Post-infarction left ventricular remodeling is associated with increased mortality in patients with ischemic heart disease. Surgical ventricular reconstruction (SVR) in addition to coronary artery bypass grafting (CABG) has been proposed to reduce left ventricular volume and improve clinical outcomes. The Surgical Treatment for Ischemic Heart Failure (STICH) trial found that the addition of SVR to CABG did not reduce the rates of death or rehospitalization in the 5 years after surgery compared to CABG alone. Like all randomized trials, STICH has limitations and it has been hypothesized that it may have underestimated the treatment effect of SVR. The aim of this study is to evaluate the results of SVR in one of the largest contemporary single-center series and to compare the results with those of the STICH trial using individual patient's data.
Methods And Analysis:
Individual data of patients who underwent SVR with or without CABG will be obtained from San Donato University Hospital in Milan. Using multivariable Cox regression analysis, significant prognostic indicators in this cohort will be identified. We will then compare the San Donato cohort to individual patient's data from the SVR arm of Hypothesis 2 of the STICH trial and from both arms of the STICH Extended Study (STICHES). To reduce confounders, propensity score adjustment will be used for this comparison. The primary endpoint will be all-cause mortality. Data will be merged and analyzed independently at Weill Cornell Medicine in New York.
