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THE ROLE OF SURGERY IN HEART FAILURE - part 10

CABG cộng với SVR. Giả thuyết 2 (cánh tay phẫu thuật) kiểm tra việc phẫu thuật LV hình dạng và tối ưu hóa kích thước bằng cách SVR kết hợp với thuật cải thiện sự sống còn, bệnh tật, và chất lượng cuộc sống trên CABG một mình. Bệnh nhân trong cánh tay này nên có các đặc điểm LV | HEART FAILURE SURGERY 241 CABG plus SVR. Hypothesis 2 surgical arm tests whether surgical LV shape and size optimization by SVR combined with CABG improves survival morbidity and quality of life over CABG alone. Patients in this arm should have LV characteristics amenable for SVR ie volume enlargement a certain extent of asynergy in the anterior region and potentially recoverable remote nonscarred segments . Besides the primary hypothesis the trial will answer relevant clinical questions first it will focus on the recognition of the potentially lethal complications of enlarging ventricular volume after myocardial infarction. This fundamental concept stems from the work of White and colleagues 23 showing how increased left ventricular end-systolic volume affects mortality. The congestive heart failure community recognizes that measuring LV volumes with any imaging method angiography echocardiography nuclear imaging studies cardiac magnetic resonance is an important measurement that reflects a major change from conventional analysis because ejection fraction is now the accepted traditional prognostic indicator. Nonrandomized studies 24 in which the entry criterion was LVESVI of approximately 60 mL m2 that compared medical therapy and CABG demonstrated that prognosis was determined by LVESVI changes over 4 years and was independent of the treatment category. Second an important concept that the STICH trial will address is the potential recovery of function of remote nonscarred regions after the scar is excluded by SVR we will learn by means of magnetic resonance imaging ventriculography echocardiography and nuclear medicine studies of remote regions if there is sufficient compensatory muscle to resume function. As for the primary hypothesis of restoration the trial will definitively demonstrate whether the reduction of volume induced by SVR and the surgical exclusion of the scar associated with CABG will add benefits to patients who have dilated ischemic .