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Surgical Ventricular Restoration and the STICH Trial

Italy
¹ Japan

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Chronic ischemic heart failure has become a major public health problem in the western world, partly due to an aged population and more effective treatment of acute myocardial infarction (MI).¹ Despite significant improvements in medical management, patients with ischemic heart failure are repeatedly readmitted for hospital care, and the majority will die within 3 years of diagnosis.² Chronic ischemic cardiomyopathy is the negative result of so-called ventricular remodeling, characterized by a left ventricular (LV) volume increase and abnormal geometry, and frequently associated with mitral regurgitation.³ The concept of reducing wall stress through surgical restoration of LV cavity size and geometry is the guiding principle behind many innovative techniques aimed at improving heart failure of ischemic and nonischemic origin. Heart transplantation remains the treatment of choice for dilated cardiomyopathy, although in ischemic patients, operative risk is higher and survival lower than in those with nonischemic cardiomyopathy. Thus restoring myocardial perfusion (vessel), eliminating valvular regurgitation (valve), and restoring ventricular geometry (ventricle) has emerged as the first-line surgical approach (3V approach) to heart failure, because it can be performed in a single operation.⁴ Results of LV reconstruction have been favorable and consistent among groups, regardless of whether endoventricular circular patch plasty or a modified linear patch closure technique is used.^5,6 Significant reductions in LV end-systolic volume index and improvements in ejection fraction, New York Heart Association class, and long-term survival have resulted. This surgical treatment, when combined with optimal medical management of heart failure, may now . . . [Full Text of this Article]