Surgical ventricular restoration: where do we go from here?

The surgical treatment for ischemic heart failure (STICH) trial concluded that the addition of surgical ventricular restoration (SVR) to coronary bypass grafting did not lead to improved survival in patients with dilated ischemic cardiomyopathy. Observational studies at multiple centers over the last 15 years have shown consistent improvement in global ventricular function and approximately 70 % long-term survival. The causes of this discrepancy are reviewed here and likely relate to how the STICH trial was conducted. Recent subset analyses from the STICH investigators have provided some additional data relating ventricular volumes to outcomes. However, including patients with unsuitable entry criteria and operations confounds the data. We recommend an analysis of the STICH data based on the trial's initial design in order to determine if there are patients who may benefit by SVR.