Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction

By Robert H. Jones, E. Velazquez, R. Michler, G. Sopko, J. Oh, C. O'connor, James A. Hill, L. Menicanti, Z. Sadowski, P. Desvigne‐Nickens and 2 more. New England Journal of Medicine, 2009

688 citations recorded by the source corpus.

BACKGROUND Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular reconstruction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone. METHODS Between September 2002 and January 2006, a total of 1000 patients with an ejection fraction of 35% or less, coronary artery disease that was amenable to CABG, and dominant anterior left ventricular dysfunction that was amenable to surgical ventricular reconstruction were randomly assigned to undergo either CABG alone (499 patients) or CABG with surgical ventricular reconstruction (501 patients). The primary outcome was a composite of death from any cause and hospitalization for cardiac causes. The median follow-up was 48 months. RESULTS Surgical ventricular reconstruction reduced the end-systolic volume index by 19%, as compared with a reduction of 6% with CABG alone. Cardiac symptoms and exercise tolerance improved from baseline to a similar degree in the two study groups. However, no significant difference was observed in the primary outcome, which occurred in 292 patients (59%) who were assigned to undergo CABG alone and in 289 patients (58%) who were assigned to undergo CABG with surgical ventricular reconstruction (hazard ratio for the combined approach, 0.99; 95% confidence interval, 0.84 to 1.17; P = 0.90). CONCLUSIONS Adding surgical ventricular reconstruction to CABG reduced the left ventricular volume, as compared with CABG alone. However, this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes. (ClinicalTrials.gov number, NCT00023595.)

Subfields: Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and Imaging, Surgery

View Paper: https://www.semanticscholar.org/paper/8cbf8042617362a75b4ae6f17c229879a0aa83bb

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Cardiology and Cardiovascular Medicine

  1. Jeroen J. Bax
  2. Helmut Baumgartner
  3. Paulus Kirchhof
  4. Gerasimos Filippatos
  5. Frank Flachskampf
  6. Volkmar Falk
  7. M. Flemmer
  8. P. Marik

In Radiology, Nuclear Medicine and Imaging

  1. Frank Flachskampf

In Surgery

  1. P. Marik

Citations in the corpus