Document Detail

Myocardial viability and impact of surgical ventricular reconstruction on outcomes of patients with severe left ventricular dysfunction undergoing coronary artery bypass surgery: Results of the Surgical Treatment for Ischemic Heart Failure trial.
MedLine Citation:
PMID:  25152476     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVES: In the Surgical Treatment for Ischemic Heart Failure trial, surgical ventricular reconstruction plus coronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalization compared with bypass alone. We hypothesized that the absence of viable myocardium identifies patients with coronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypass graft surgery and surgical ventricular reconstruction compared with bypass alone.
METHODS: Myocardial viability was assessed by single photon computed tomography in 267 of the 1000 patients randomized to bypass or bypass plus surgical ventricular reconstruction in the Surgical Treatment for Ischemic Heart Failure. Myocardial viability was assessed on a per patient basis and regionally according to prespecified criteria.
RESULTS: At 3 years, there was no difference in mortality or the combined outcome of death or cardiac hospitalization between those with and without viability, and there was no significant interaction between the type of surgery and the global viability status with respect to mortality or death plus cardiac hospitalization. Furthermore, there was no difference in mortality or death plus cardiac hospitalization between those with and without anterior wall or apical scar, and no significant interaction between the presence of scar in these regions and the type of surgery with respect to mortality.
CONCLUSIONS: In patients with coronary artery disease and severe regional left ventricular dysfunction, assessment of myocardial viability does not identify patients who will derive a mortality benefit from adding surgical ventricular reconstruction to coronary artery bypass graft surgery.
Thomas A Holly; Robert O Bonow; J Malcolm O Arnold; Jae K Oh; Padmini Varadarajan; Gerald M Pohost; Haissam Haddad; Robert H Jones; Eric J Velazquez; Bozena Birkenfeld; Federico M Asch; Marcin Malinowski; Rodrigo Barretto; Renato A K Kalil; Daniel S Berman; Jie-Lena Sun; Kerry L Lee; Julio A Panza
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Publication Detail:
Type:  Journal Article     Date:  2014-07-30
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  148     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2014 Dec 
Date Detail:
Created Date:  2014-12-01     Completed Date:  -     Revised Date:  2014-12-02    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2677-2684.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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