New Surgery for Heart Failure Proves I... (the left ventricle. After surgeons iden...)

New Surgery for Heart Failure Proves Ineffective

Date:3/29/2009

the left ventricle. After surgeons identify the damaged part, they basically sew the healthy part together. After tightening the sutures, the surgeons place a patch over the damaged tissue, leaving the damaged tissue outside the ventricle.

During 48 months of follow-up, the researchers found that people who underwent both procedures had 19 percent less "end-systolic volume" -- the amount of blood left in the ventricle after contraction and before it starts filling again. This compared with 6 percent less volume for those who had just bypass surgery.

But, people who had their hearts surgically altered did not show improvement in symptoms, the ability to exercise or a reduction in deaths or hospitalizations for heart problems.

"This is an outstanding example of the essential need to test new cardiovascular therapies and surgical approaches in randomized, controlled clinical trials," Fonarow said.

Another heart expert agreed that the study demonstrates that ventricular reconstruction is not effective.

"Enlarged hearts don't function as well as small ones, so cardiologists thought that a procedure to shrink the main heart chamber would help," said Dr. Byron Lee, an assistant professor of medicine at the University of California, San Francisco.

"However, this study convincingly shows that this type of surgical reconstruction is of no benefit to patients undergoing bypass operations," Lee said.

Dr. Elizabeth G. Nabel, director of the U.S. National Heart, Lung and Blood Institute, which funded the study, described the research as having "tremendous public health importance since it provides much-needed clinical, trial-based evidence to help physicians choose the best treatment for their heart failure patients."

She added, in a prepared statement, that it also was "a superb example of comparative effectiveness research, allowing evaluation of real-world treatments in hopes of improving
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