title: Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction.
abstract: 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.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY. Electronic address: rmichler@montefiore.org.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Michler
authors.forename: Jean L
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Hussein R
authors.initials: HR
authors.lastname: Al-Khalidi
authors.forename: Robert O
authors.initials: RO
authors.lastname: Bonow
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Pohost
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Holly
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Francois
authors.initials: F
authors.lastname: Dagenais
authors.forename: Carmelo
authors.initials: C
authors.lastname: Milano
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wrobel
authors.forename: Jan
authors.initials: J
authors.lastname: Pirk
authors.forename: Imtiaz S
authors.initials: IS
authors.lastname: Ali
authors.forename: Robert H
authors.initials: RH
authors.lastname: Jones
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Marisa
authors.initials: M
authors.lastname: Di Donato
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: 22; 23; CABG; ESVI; LV; STICH; SVR; Surgical Treatment for Ischemic Heart Failure; coronary artery bypass grafting; end-systolic volume index; left ventricular; surgical ventricular reconstruction