Document Detail


Insights from the STICH trial: Change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction.
MedLine Citation:
PMID:  23111018     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: The present analysis of the Surgical Treatment for Ischemic Heart Failure randomized trial data examined the left ventricular volumes at baseline and 4 months after surgery to determine whether any magnitude of postoperative reduction in end-systolic volume affected survival after coronary artery bypass grafting alone compared with bypass grafting plus surgical ventricular reconstruction. METHODS: Of the 1000 patients randomized, 555 underwent an operation and had a paired imaging assessment with the same modality at baseline and 4 months postoperatively. Of the remaining 455 patients, 424 either died before the 4-month study or did not have paired imaging tests and were excluded, and 21 were not considered because they had died before surgery or did not receive surgery. RESULTS: Surgical ventricular reconstruction resulted in improved survival compared with coronary artery bypass grafting alone when the postoperative end-systolic volume index was 70 mL/m(2) or less. However, the opposite was true for patients achieving a postoperative volume index greater than 70 mL/m(2). A reduction in the end-systolic volume index of 30% or more compared with baseline was an infrequent event in both treatment groups and did not produce a statistically significant survival benefit with ventricular reconstruction. CONCLUSIONS: In patients undergoing coronary artery bypass grafting plus surgical ventricular reconstruction, a survival benefit was realized compared with bypass alone, with the achievement of a postoperative end-systolic volume index of 70 mL/m(2) or less. Extensive ventricular remodeling at baseline might limit the ability of ventricular reconstruction to achieve a sufficient reduction in volume and clinical benefit.
Authors:
Robert E Michler; Jean L Rouleau; Hussein R Al-Khalidi; Robert O Bonow; Patricia A Pellikka; Gerald M Pohost; Thomas A Holly; Jae K Oh; Francois Dagenais; Carmelo Milano; Krzysztof Wrobel; Jan Pirk; Imtiaz S Ali; Robert H Jones; Eric J Velazquez; Kerry L Lee; Marisa Di Donato;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-27
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  -     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY. Electronic address: rmichler@montefiore.org.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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