ACC: Combo Surgery Not Beneficial in Heart Failure

Adding surgical ventricular reconstruction to bypass grafting has no effect on mortality

MONDAY, March 30 (HealthDay News) -- In patients with heart failure caused by coronary artery disease, outcomes are not significantly different in those who undergo coronary-artery bypass grafting with surgical ventricular reconstruction than in those who undergo coronary-artery bypass grafting alone, according to the results of a study published online March 29 in the New England Journal of Medicine to coincide with the American College of Cardiology's 58th Annual Scientific Session held March 29 to 31 in Orlando, Fla.

Robert H. Jones, M.D., of the Duke University Medical Center in Durham, N.C., and colleagues randomly assigned 1,000 patients to undergo either coronary-artery bypass grafting with surgical ventricular reconstruction or coronary-artery bypass grafting alone.

After a median follow-up of 48 months, the researchers found no significant group difference in the primary outcome: a composite of death from any cause and hospitalization for cardiac causes (58 percent in the combined-treatment group, 59 percent in the coronary-artery bypass grafting alone group). They also found that the combined treatment reduced the end-systolic volume index by 19 percent while coronary-artery bypass grafting alone reduced it by 6 percent.

"On the basis of this trial, the routine use of surgical ventricular reconstruction in addition to coronary-artery bypass grafting cannot be justified," states the author of an accompanying editorial. "Potential explanations for the lack of added efficacy of the combined procedure include the fact that current heart-failure therapies are very effective at limiting adverse remodeling. The addition of coronary-artery bypass grafting may have enhanced this process, leaving little room for additional benefit from surgical ventricular reconstruction. We will have to wait for the results of the Hypothesis 1 substudy of the trial to know for sure."

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