Is it worth performing surgical ventricular restoration in patients with ischemic cardiomyopathy and akinetic but non-aneurysmal segments in the left ventricle?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is worth performing surgical ventricular restoration (SVR) in patients with ischemic cardiomyopathy and akinetic but non-aneurysmal segments in the left ventricle. Altogether 237 papers were identified using the below mentioned search. Fifteen presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group, relevant outcomes and weaknesses were tabulated. The RESTORE group and others have demonstrated that in patients with ischaemic cardiomyopathy and an akinetic anterior ventricular wall, significant improvements in survival and symptoms can be obtained with an acceptable operative risk. Improvements in EF of 10-15% have been consistently demonstrated with significant improvements in symptoms also. The RESTORE group peri-operative mortality was 5.3%. Currently, 25% of US centres participating in the National Cardiac Database have performed at least one SVR procedure, although most only perform low numbers. In this database over 2 years from 2002, there were 731 procedures. The mortality was 9.4% and 33% of patients suffered a major complication or death, cautioning that in the 'real-world' results may not be as good as those from high volume tertiary referral centres. Patient selection may be a reason for these differences. The STICH trial has now completed the recruitment of 2136 patients into a randomised trial of medical therapy vs. coronary artery bypass grafting (CABG) vs. CABG and SVR surgery. With first results expected in 2009, this study will be a landmark in providing the evidence base for the selection of patients for surgical ventricular restoration surgery.
Subramanian
Hariharan
H
Cardiology Department, Drexel University College of Medicine, Philadelphia, PA, USA. hsubrama@DrexelMed.edu
Kunadian
Babu
B
Dunning
Joel
J
D000368:Aged; D019985:Benchmarking; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D009202:Cardiomyopathies / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D012042:Registries; D018570:Risk Assessment; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*