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Surgical Interventions in Heart Failure

List of key references prepared and regularly updated by the Heart Failure Association (HFA)

The impact of donor-recipient sex matching on survival after orthotopic heart transplantation: analysis of 18 000 transplants in the modern era.

Weiss ES, Allen JG, Patel ND, Russell SD, Baumgartner WA, Shah AS, Conte JV.
Circ Heart Fail 2009;2(5):401-8.

The paper presents the data from the multi-institutional prospectively collected United Network for Organ Sharing (UNOS) open transplantation cohort to review 18 240 adult patients who received orthotopic heart transplantation from 1999 to 2007.  All cause posttransplant mortality was compared with regard to the sex match between donors and recipients.  Male recipients had better outcomes when received a heart from a male donor as compared to those who received a heart from a female donor.  Female recipients had higher mortality irrespective of donor sex.  There was no difference in survival in women receiving male versus female heart.

It remains unclear to what extent a match between donor and recipient sex influence outcomes in orthotopic heart transplantation.  Previous studies suggested that female donor sex might be an independent predictor of high mortality, whereas most heart recipients have traditionally been men.  The presented data suggest that men should receive hearts from male donors when feasible, whereas sex match is of minor importance in women.

Coronary bypass surgery with or without surgical ventricular reconstruction.

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; STICH Hypothesis 2 Investigators.
N Engl J Med. 2009 Apr 23;360(17):1705-17.

The STICH trial tested the hypothesis about the superiority in coronary-artery bypass grafting ( CABG ) combined with left ventricular reconstruction compared with CABG alone.  The study comprised 1000 patients with symptomatic significant left ventricular systolic dysfunction (LVEF ≤35%), coronary artery disease, dominant anterior akinesia or dyskinesia of left ventricle wall and qualification for surgery revascularization.  During 48-month follow-up surgical ventricular reconstruction reduced the left ventricular end systolic volume by 19% versus a 6% reduction in a group with CABG alone, but it was associated with any change in neither exercise tolerance nor outcome (defined as all-cause mortality and hospitalization due to cardiac reasons).

The STICH trial tested the very important hypothesis regarding the beneficial effects of surgical ventricular reconstruction added to standard coronary artery by-pass grafting in patients with ischaemic chronic heart failure.  Nevertheless, the results from this large multicenter trial that recruited in total 1000 patients failed to show any additional clinical benefits of such an intervention in the context of improvement of exercise capacity or prognosis.  Additional post-hoc analyses are underway in order to test whether specific subgroups of patients could benefit from surgical ventricular reconstruction.