Current Status of Surgical Ventricular Restoration for Ischemic Cardiomyopathy

Over the past 3 decades, several observational studies established a role for surgical ventricular restoration (SVR) in the treatment of ischemic cardiomyopathy. In 2009, the Surgical Treatment for Ischemic Heart Failure (STICH) trial reported their findings and found no benefit of adding SVR to coronary artery bypass surgery in ischemic dilated cardiomyopathy. The STICH findings precipitated a decline in interest in SVR. In this article, we review the historical background and observational data that established a role for SVR. We critically review the STICH trial, and contend that the limitations are such that the study cannot provide any reliable conclusion on the role of SVR because of suboptimal patient selection and inadequacy of volume reduction (only 19% mean reduction in volume). Several post-STICH publications continue to demonstrate that SVR is effective in dilated ventricles, provided the procedure achieves >30% volume reduction. It is critical that surgeons continue their work in SVR, and continue to analyze their data, to enable better clarification of the indications and future role for this procedure.