Surgical Ventricular Restoration Procedure: Single-Center Comparison of Surgical Treatment of Ischemic Heart Failure (STICH) Versus Non-STICH Patients

• Published in: The Annals of thoracic surgery Vol. 95; no. 2; pp. 506 - 512
• Main Authors: Goh, Siew, MBChB, Prior, David, PhD, Newcomb, Andrew, FRACS, McLellan, Alexander, MBBS, Mack, Jane, BA, Callaghan, Sue, BAppSc, Dimitriou, Jim, MBBS, Rosalion, Alexander, FRACS, Nixon, Ian, FRACS, Yii, Michael, MS, FRACS
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2013
• Subjects: Aged; Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Female; Heart Failure - etiology; Heart Failure - surgery; Heart Ventricles - surgery; Humans; Male; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - surgery; Prospective Studies; Surgery; 22; 23
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.10.041

Background Surgical ventricular restoration (SVR) was conceived to improve hemodynamic and clinical outcomes in ischemic cardiomyopathy. The Surgical Treatment of Ischemic Heart Failure (STICH) trial has conclusively shown no additional benefits of SVR when routinely combined with coronary artery bypass surgery. However, the STICH study did not include a registry arm for SVR-eligible patients who were not randomized. This study describes the SVR experience in a single center when participating in the STICH study, to better understand the role of SVR in current clinical practice. Methods All patients receiving SVR between 2002 and 2006 were prospectively followed. Patients were divided into STICH SVR (SSVR) and non-STICH SVR (NSSVR) groups. The SSVR patients received SVR as randomized in STICH. The NSSVR patients were evaluated for eligibility to participate in the STICH trial, and the reasons for not participating were analyzed. Baseline demographics, echocardiographic data, and clinical outcomes were compared. Results Nine NSSVR patients were compared with 12 SSVR patients. Only 1 NSSVR patient did not fulfill entry criteria into the STICH trial for randomization. The main reason for performing SVR outside of the STICH study was dominant heart failure symptom associated with enlarged left ventricle. The NSSVR group had more anterior wall asynergy (60% vs 45%, p < 0.001), larger preoperative heart volumes (left ventricular end-diastolic volume index 108 mL/m2 vs 69 mL/m2 , p < 0.05) and larger volume reductions (34% vs 11%, p = 0.06). At 6.5-year follow-up, 83% SSVR and 89% NSSVR patients are alive. Conclusions At our institution, patients eligible but not randomized into STICH, had larger preoperative heart volumes and larger volume reduction with SVR. The STICH study may not have included patients most likely to benefit from SVR.