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Role of surgical ventricular restoration post surgical treatment of heart failure (STICH) trial

  • Anjith Prakash RajakumarEmail author
  • Mithun Sundararaaja Ravikumar
  • Vijayanand Palanisamy
  • Karthik Raman
  • Anbarasu Mohanraj
  • Jacob Jamesraj
  • Valikapthalil Mathew Kurian
  • Mullasari Ajit
  • Rajan Sethuratnam
Original Article
  • 13 Downloads

Abstract

Objective

To compare the outcomes of isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) with or without CABG for patients with ischemic cardiomyopathy (ICM).

Methods

Retrospectively, 49 patients with ICM and severe LV dysfunction (LVEF < 35%) who underwent SVR with or without CABG from January 2009 to December 2016 at a single institution was compared with 49 patients who underwent isolated CABG. The two groups were matched for preoperative clinical and echocardiographic parameters including left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV). Primary outcomes analyzed included early mortality, late mortality, and major adverse cardiac or cerebrovascular events (MACCE). Secondary outcomes analyzed included echocardiographic parameters of left ventricular volume and function-indexed left ventricular end-diastolic volume (LVEDVi), indexed left ventricular end-systolic volume (LVESVi), and LVEF. Cox and survival analysis was performed.

Results

Early and late mortality in SVR vs. CABG groups were 4 (8.1%) and 6 (12.2%) vs. 1 (2%) and 5 (10.2%) respectively. Mean improvement in LVEF was 3.39 ± 7.51 compared to 4.97 ± 5.45 between the two groups at 3-month follow-up. Mean improvement in LVEF was 5.1 ± 8.3 in the SVR group vs 5.9 ± 7.1 in the CABG group at the last follow-up. There was no statistically significant improvement between the two groups in terms of LVEF at 3 months or the last follow-up. There were statistically significant differences between LVEDVi and LVESVi between the two groups at 3 months and the last follow-up. The 5-year rates of survival were 85 ± 6 and 82 ± 9% for SVR and CABG groups respectively. The 5-year rates of freedom from MACCE were 75 ± 7 and 60 ± 11% for SVR and CABG groups respectively.

Conclusion

Compared with isolated CABG, SVR plus CABG results in equivalent late mortality and better left ventricular reverse remodeling (as evidenced by LV volume reduction) and better freedom from MACCE at 5-year follow-up.

Keywords

Stich trial Dor’s ventriculoplasty MACCE 

Notes

Acknowledgments

We acknowledge the statistical analysis and support provided by Dr. Balaji, Assistant Professor, Department of Community Medicine, The Madras Medical College.

Presentation at meetings

Nil

Compliance with ethical standards

Institutional review board approval has been obtained for the publishing of patient profile and this article.

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

For this type of study formal consent is not required.

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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Anjith Prakash Rajakumar
    • 1
    Email author
  • Mithun Sundararaaja Ravikumar
    • 1
  • Vijayanand Palanisamy
    • 1
  • Karthik Raman
    • 1
  • Anbarasu Mohanraj
    • 1
  • Jacob Jamesraj
    • 1
  • Valikapthalil Mathew Kurian
    • 1
  • Mullasari Ajit
    • 2
  • Rajan Sethuratnam
    • 1
  1. 1.Department of Cardiac SurgeryInstitute of Cardiovascular Diseases, The Madras Medical MissionChennaiIndia
  2. 2.Department of CardiologyInstitute of Cardiovascular Diseases, The Madras Medical MissionChennaiIndia

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