The STICH trial: Misguided conclusions

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Presentation transcript:

The STICH trial: Misguided conclusions Gerald D. Buckberg, MD, Constantine L. Athanasuleas, MD The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 5, Pages 1060-1064.e2 (November 2009) DOI: 10.1016/j.jtcvs.2009.07.015 Copyright © 2009 Terms and Conditions

Figure 1 Changes in LV size and shape after SVR. The elliptical normal form (A) becomes spherical after anterior septal infarction (B). Size and shape are returned toward a more normal elliptical configuration by placing a patch to exclude the scar and returning nonscarred remote muscle back to its conical form (C). Reprinted with permission from Buckberg G. Ventricular Structure and surgical history. Heart Failure Rev. 2005;9:255-68. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1060-1064.e2DOI: (10.1016/j.jtcvs.2009.07.015) Copyright © 2009 Terms and Conditions

Figure 2 A, Relationship between LV end-systolic volume and mortality. Note (1) that volume is in milliliters, not milliliters per square meter, so that the LV end-systolic volume index would be twice this number if patient size were 2m2 and (2) that volume increase is a surrogate for increased mortality.2 B, Comparison of prognosis in survivors and nonsurvivors in relationship to ejection fraction (solid line is at 35%) and LV end-systolic volume in milliliters. Note that lower LV end-systolic volume at 35% ejection fraction is associated with reduced mortality in survivors compared with increased mortality in nonsurvivors when LV end-systolic volume is higher at 35% ejection fraction.2MI, Myocardial infarction; LVESV, left ventricular end-systolic volume. Reprinted with permission.2 The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1060-1064.e2DOI: (10.1016/j.jtcvs.2009.07.015) Copyright © 2009 Terms and Conditions

Figure 3 Overall hospital and late follow up mortality in patients with congestive heart failure (CHF) after medical therapy, as reported by the Framingham analysis,6 coronary revascularization (reprinted with permission),7 and surgical ventricular restoration (reprinted with permission).4 The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1060-1064.e2DOI: (10.1016/j.jtcvs.2009.07.015) Copyright © 2009 Terms and Conditions

Figure E1 Adverse effects on postoperative mortality after aortic valve replacement (AVR) when LV end-systolic volume dimension exceeds 55 mm. Similar adverse changes were reported after end-systolic volume index exceeded 55 mL/m2.18LVD(S), Left ventricular diameter (systolic). Reprinted with permission.18 The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1060-1064.e2DOI: (10.1016/j.jtcvs.2009.07.015) Copyright © 2009 Terms and Conditions

Figure E2 Time -related cost of health care due to physician visits in the congestive heart failure (CHF) population, when costs were estimated during a time intervals between 2005 and 2030. Reprinted with permission.27 The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1060-1064.e2DOI: (10.1016/j.jtcvs.2009.07.015) Copyright © 2009 Terms and Conditions