Surgical Ventricular Reconstruction Has a Role in Surgical Remodeling in Patients with LV Systolic Dysfunction Even Post-STICH?

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Abstract

The Hypothesis 2 arm of the STICH trial compared outcomes in ischemic cardiomyopathy patients undergoing CABG plus SVR vs. CABG alone. Although the trial results suggest equivalency of these therapies, important trial flaws have been identified which cast critical doubt regarding the generalizability of the trial findings.

Section snippets

STICH and Hypothesis 2

The STICH trial aimed to provide evidence-based support for two hypotheses. Hypothesis 1 was that patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) would have improved survival and freedom from death from cardiac causes than patients receiving medical therapy only.1 This hypothesis was not supported. Hypothesis 2 was that patients with ischemic cardiomyopathy undergoing CABG and surgical ventricular restoration (SVR) would have improved survival and freedom

Additional single-center data

After the release of this trial, Dr. Dor analyzed the efficacy of endoventricular patch plasty in patients with ventricular aneurysms who did not meet the inclusion criteria for the STICH trial.10 During the time period of 2002–2008, 274 patients underwent LV remodeling (LVR) for ischemic cardiomyopathy. Of this cohort, 117 of these patients (mean age 64 years; range 34–83) would not have been eligible for the STICH trial. The pertinent exclusion criterion included: 12 patients with no coronary

Conclusions

Unfortunately, the STICH trial has greatly “muddied the waters” regarding the impact of SVR. Analysis of this study, its execution, and subset analyses will be ongoing for the next decade. Novel and alternative approaches to reshaping the myopathic ventricle have been appropriately tested on a small scale in multiple studies that have demonstrated dramatic impact in myofiber stress reduction and patient survival. Further large-scale randomized studies will be necessary to ultimately determine

Statement of Conflict of Interest

The authors report no conflicts of interest related to this work.

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