Coronary bypass surgery with or without surgical ventricular reconstruction

Robert H. Jones, Eric J. Velazquez, Robert E. Michler, George Sopko, Jae K. Oh, Christopher M. O'Connor, James A. Hill, Lorenzo Menicanti, Zygmunt Sadowski, Patrice Desvigne-Nickens, Jean Lucien Rouleau, Kerry L. Lee

Research output: Contribution to journalArticle

461 Citations (Scopus)

Abstract

BACKGROUND: Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular reconstruction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone. METHODS: Between September 2002 and January 2006, a total of 1000 patients with an ejection fraction of 35% or less, coronary artery disease that was amenable to CABG, and dominant anterior left ventricular dysfunction that was amenable to surgical ventricular reconstruction were randomly assigned to undergo either CABG alone (499 patients) or CABG with surgical ventricular reconstruction (501 patients). The primary outcome was a composite of death from any cause and hospitalization for cardiac causes. The median follow-up was 48 months. RESULTS: Surgical ventricular reconstruction reduced the end-systolic volume index by 19%, as compared with a reduction of 6% with CABG alone. Cardiac symptoms and exercise tolerance improved from baseline to a similar degree in the two study groups. However, no significant difference was observed in the primary outcome, which occurred in 292 patients (59%) who were assigned to undergo CABG alone and in 289 patients (58%) who were assigned to undergo CABG with surgical ventricular reconstruction (hazard ratio for the combined approach, 0.99; 95% confidence interval, 0.84 to 1.17; P = 0.90). CONCLUSIONS: Adding surgical ventricular reconstruction to CABG reduced the left ventricular volume, as compared with CABG alone. However, this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes. (ClinicalTrials. gov number, NCT00023595.)

Original languageEnglish (US)
Pages (from-to)1705-1717
Number of pages13
JournalNew England Journal of Medicine
Volume360
Issue number17
DOIs
StatePublished - Apr 23 2009

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Coronary Artery Bypass
Hospitalization
Exercise Tolerance
Coronary Artery Disease
Mortality
Left Ventricular Dysfunction
Cause of Death
Heart Failure
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Jones, R. H., Velazquez, E. J., Michler, R. E., Sopko, G., Oh, J. K., O'Connor, C. M., ... Lee, K. L. (2009). Coronary bypass surgery with or without surgical ventricular reconstruction. New England Journal of Medicine, 360(17), 1705-1717. https://doi.org/10.1056/NEJMoa0900559

Coronary bypass surgery with or without surgical ventricular reconstruction. / Jones, Robert H.; Velazquez, Eric J.; Michler, Robert E.; Sopko, George; Oh, Jae K.; O'Connor, Christopher M.; Hill, James A.; Menicanti, Lorenzo; Sadowski, Zygmunt; Desvigne-Nickens, Patrice; Rouleau, Jean Lucien; Lee, Kerry L.

In: New England Journal of Medicine, Vol. 360, No. 17, 23.04.2009, p. 1705-1717.

Research output: Contribution to journalArticle

Jones, RH, Velazquez, EJ, Michler, RE, Sopko, G, Oh, JK, O'Connor, CM, Hill, JA, Menicanti, L, Sadowski, Z, Desvigne-Nickens, P, Rouleau, JL & Lee, KL 2009, 'Coronary bypass surgery with or without surgical ventricular reconstruction', New England Journal of Medicine, vol. 360, no. 17, pp. 1705-1717. https://doi.org/10.1056/NEJMoa0900559
Jones, Robert H. ; Velazquez, Eric J. ; Michler, Robert E. ; Sopko, George ; Oh, Jae K. ; O'Connor, Christopher M. ; Hill, James A. ; Menicanti, Lorenzo ; Sadowski, Zygmunt ; Desvigne-Nickens, Patrice ; Rouleau, Jean Lucien ; Lee, Kerry L. / Coronary bypass surgery with or without surgical ventricular reconstruction. In: New England Journal of Medicine. 2009 ; Vol. 360, No. 17. pp. 1705-1717.
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abstract = "BACKGROUND: Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular reconstruction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone. METHODS: Between September 2002 and January 2006, a total of 1000 patients with an ejection fraction of 35{\%} or less, coronary artery disease that was amenable to CABG, and dominant anterior left ventricular dysfunction that was amenable to surgical ventricular reconstruction were randomly assigned to undergo either CABG alone (499 patients) or CABG with surgical ventricular reconstruction (501 patients). The primary outcome was a composite of death from any cause and hospitalization for cardiac causes. The median follow-up was 48 months. RESULTS: Surgical ventricular reconstruction reduced the end-systolic volume index by 19{\%}, as compared with a reduction of 6{\%} with CABG alone. Cardiac symptoms and exercise tolerance improved from baseline to a similar degree in the two study groups. However, no significant difference was observed in the primary outcome, which occurred in 292 patients (59{\%}) who were assigned to undergo CABG alone and in 289 patients (58{\%}) who were assigned to undergo CABG with surgical ventricular reconstruction (hazard ratio for the combined approach, 0.99; 95{\%} confidence interval, 0.84 to 1.17; P = 0.90). CONCLUSIONS: Adding surgical ventricular reconstruction to CABG reduced the left ventricular volume, as compared with CABG alone. However, this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes. (ClinicalTrials. gov number, NCT00023595.)",
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AU - Jones, Robert H.

AU - Velazquez, Eric J.

AU - Michler, Robert E.

AU - Sopko, George

AU - Oh, Jae K.

AU - O'Connor, Christopher M.

AU - Hill, James A.

AU - Menicanti, Lorenzo

AU - Sadowski, Zygmunt

AU - Desvigne-Nickens, Patrice

AU - Rouleau, Jean Lucien

AU - Lee, Kerry L.

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N2 - BACKGROUND: Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular reconstruction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone. METHODS: Between September 2002 and January 2006, a total of 1000 patients with an ejection fraction of 35% or less, coronary artery disease that was amenable to CABG, and dominant anterior left ventricular dysfunction that was amenable to surgical ventricular reconstruction were randomly assigned to undergo either CABG alone (499 patients) or CABG with surgical ventricular reconstruction (501 patients). The primary outcome was a composite of death from any cause and hospitalization for cardiac causes. The median follow-up was 48 months. RESULTS: Surgical ventricular reconstruction reduced the end-systolic volume index by 19%, as compared with a reduction of 6% with CABG alone. Cardiac symptoms and exercise tolerance improved from baseline to a similar degree in the two study groups. However, no significant difference was observed in the primary outcome, which occurred in 292 patients (59%) who were assigned to undergo CABG alone and in 289 patients (58%) who were assigned to undergo CABG with surgical ventricular reconstruction (hazard ratio for the combined approach, 0.99; 95% confidence interval, 0.84 to 1.17; P = 0.90). CONCLUSIONS: Adding surgical ventricular reconstruction to CABG reduced the left ventricular volume, as compared with CABG alone. However, this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes. (ClinicalTrials. gov number, NCT00023595.)

AB - BACKGROUND: Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular reconstruction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone. METHODS: Between September 2002 and January 2006, a total of 1000 patients with an ejection fraction of 35% or less, coronary artery disease that was amenable to CABG, and dominant anterior left ventricular dysfunction that was amenable to surgical ventricular reconstruction were randomly assigned to undergo either CABG alone (499 patients) or CABG with surgical ventricular reconstruction (501 patients). The primary outcome was a composite of death from any cause and hospitalization for cardiac causes. The median follow-up was 48 months. RESULTS: Surgical ventricular reconstruction reduced the end-systolic volume index by 19%, as compared with a reduction of 6% with CABG alone. Cardiac symptoms and exercise tolerance improved from baseline to a similar degree in the two study groups. However, no significant difference was observed in the primary outcome, which occurred in 292 patients (59%) who were assigned to undergo CABG alone and in 289 patients (58%) who were assigned to undergo CABG with surgical ventricular reconstruction (hazard ratio for the combined approach, 0.99; 95% confidence interval, 0.84 to 1.17; P = 0.90). CONCLUSIONS: Adding surgical ventricular reconstruction to CABG reduced the left ventricular volume, as compared with CABG alone. However, this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes. (ClinicalTrials. gov number, NCT00023595.)

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