Heart failure surgery studies

Question 1

MADIT

Answer 1

Multicenter Automatic Defibrillator Implantation Trial
Prospective, randomised controlled study in 196 pt with
1) previous MI
2) EF < 35%
3) documented episode of asymptomatic unsustained VTach
ICD (95) vs anti-arrhythmic (101)
27% reduction in mortality in the ICD group.
ICD leads to improved survival in pts with previous MI, low EF and high risk for Vtach.

Question 2

MUSTIC

Answer 2

Multisite Stimulation in Cardiomyopathies
Prospective, randomised controlled study in 48 pts with
1) NHYA IV
2) EF < 35%
3) NSR with QRS > 150 msec
Pts received transvenous atrio-biventricular pacemalers and the study compared 3 month outcomes
Bi ventricular pacing leads to improved quality of life and exercise tolerance (improved by 23% and reduced rate of hospitalization.

Question 3

HEARTMATE II

Answer 3

Prospective randomised study in 200 patients with advanced heart failure who were ineligible for transplantation
The patients were randomised in a 2:1 ratio
Group 1 (134) –implantation of a continuous flow left ventricular assist device (Thoratec Heartmate II)
Group 2 (66)–Pulsatile flow left ventricular assist device (Heartmate I)
Survival advantage at 2 years for patients in the continous flow (HEARTMATE II) 58% vs 24%
Reduced adverse events for patients in the continous flow LVAD group

Question 4

RESTORE

Answer 4

Reconstructive Endoventricular Surgery returning Torsion Original Radius Elliptical shape to the left ventricle
Prospective registry of
1198 patients who underwent surgical ventricular restoration with
1) previous anterior MI
2) LVIDs volume index >60ml/2
3) regional asynergic LV circumference of >35%
Overall, this study concluded that SVR improves ventricular function and symptom status in patients with ischemic cardiomyopathy

Question 5

STITCH (hypothesis 2)

Answer 5

Prospective, randomised study of 2800 patients with
1) CAD amenable to revasculisation
2) EF < 35%
3) dominant akinesia of the anterior left ventricular wall amenable to SVR
3 groups: 1) medical therapy alone, 2) CABG + OMT 3) SVR + CABG + OMT
Hypothesis 2 SVR when added to CABG showed no significant difference in
Primary outcome
Acute myocardial infarction
stroke
symptoms

Question 6

What are details of REMATCH

Answer 6

48% reduction in the risk of the death with LVAD
It was NEJM 2001 Nov 15; 345;(20) 1435-43

All patients were ineligble for cardiac transplant

Question 7

REMATCH

Answer 7

Randomised Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure
Prospective, randomised controlled study of 129 pts with
1) end-stage heart failure
2) EF < 25%
Either Heartmate I vs Optimal medical therapy
1 year survival LVAD 52% vs OMT 25%
2 year survival LVAD 23% vs OMT 8%

LVAD is acceptable therapy when not candidate for transplant