The Journal of Thoracic and Cardiovascular Surgery
Adult: CoronaryLong-term results of surgical ventricular reconstruction and comparison with the Surgical Treatment for Ischemic Heart Failure trial
Graphical abstract
Visual summary of the study findings highlighting significantly better long-term results of SVR in an experienced center than those reported in the STICH trial, and its implications. SVR, Surgical ventricular reconstruction; STICH, Surgical Treatment for Ischemic Heart Failure trial; AHR, adjusted hazard ratio; CI, confidence interval.
Section snippets
Study Design
The aims of the study were (1) to describe the long-term outcomes in one of the largest series of SVR and (2) to compare them with the results of the STICH trial. The study for the San Donato cohort was approved by the local institutional review board (protocol #:179/int/2019).
Individual patients' data from hypothesis 1 and 2 of the STICH trial and from the STICH Extended Study (STICHES) trial were obtained through the Biologic Specimen and Data Repository Information Coordinating Center of the
San Donato Cohort
A total of 725 patients were included in the San Donato cohort. Baseline characteristics are summarized in Table 1. The median age was 66.0 (Q1, Q3: 58.0, 72.0). The majority of patients were male (n = 596, 82.3%). Most patients had hypertension, hyperlipidemia, and class NYHA II-III symptoms. One-hundred ninety-two (26.4%) patients had diabetes, 56 (7.7%) had renal failure, 202 (28.1%) underwent previous PCI, and 12 (1.7%) had a history of previous CABG. A total of 492 patients (67.8%) were
Discussion
The San Donato cohort represents one of the largest SVR series with the longest follow-up published to date. The operative mortality was 7.4%, and this highlights the added operative risk of the procedure, even when performed in a highly experienced center. The cumulative 5- and 10-year survival were 74.7% and 54.9%, respectively, which is comparable with the survival reported for patients with depressed LVEF undergoing CABG alone and better to what reported in most previous SVR studies.7, 8, 9,
References (35)
Left ventricular aneurysmectomy. Resection or reconstruction
J Thorac Cardiovasc Surg
(1985)Left ventricular reconstruction: the aim and the reality after twenty years
J Thorac Cardiovasc Surg
(2004)- et al.
Left ventricular reconstruction by endoventricular circular patch plasty repair: a 17-year experience
Semin Thorac Cardiovasc Surg
(2001) - et al.
Surgical therapy for ischemic heart failure: single-center experience with surgical anterior ventricular restoration
J Thorac Cardiovasc Surg
(2007) - et al.
Coronary artery bypass grafting with or without surgical ventricular restoration: a comparison
Ann Thorac Surg
(2008) - et al.
Akinetic versus dyskinetic postinfarction scar: relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair
J Am Coll Cardiol
(1997) - et al.
Coronary artery bypass with ventricular restoration is superior to coronary artery bypass alone in patients with ischemic cardiomyopathy
J Thorac Cardiovasc Surg
(2004) - et al.
Surgical ventricular reconstruction has a role in surgical remodeling in patients with LV systolic dysfunction even Post-STICH?
Prog Cardiovasc Dis
(2013) - et al.
STICH (surgical treatment for ischemic heart failure) trial enrollment
J Am Coll Cardiol
(2010) - et al.
Results of left ventricular reconstruction with and without mitral valve surgery
Ann Thorac Surg
(2020)
Favorable effects of left ventricular reconstruction in patients excluded from the surgical treatments for ischemic heart failure (STICH) trial
J Thorac Cardiovasc Surg
Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction
J Thorac Cardiovasc Surg
Coronary artery bypass grafting in patients with advanced left ventricular dysfunction
Ann Thorac Surg
Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy
Ann Thorac Surg
2021: the American Association for Thoracic Surgery Expert Consensus Document: coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure
J Thorac Cardiovasc Surg
Impact of surgical ventricular restoration on diastolic function: implications of shape and residual ventricular size
Ann Thorac Surg
Baseline left ventricular volume and shape as determinants of reverse remodeling induced by surgical ventricular reconstruction
Ann Thorac Surg
Cited by (0)
Gianmarco Cancelli is supported by the “Enrico and Enrica Sovena Foundation” in Rome, Italy.