Treatment of Ischemic Heart Failure

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Patients with heart failure caused by blocked coronary arteries, who are treated with bypass surgery  reduce their risk of dying from heart disease, and also the risk of death from any cause or hospitalization from heart disease, compared with medication alone.

“The trial supports bypass surgery on top of best medical therapy vs. best medical therapy alone to reduce cardiovascular morbidity and mortality,” lead researcher Dr. Eric J. Velazquez, director of both the cardiac diagnostic unit and echocardiography laboratories at Duke University Medical Center, said during a Monday press conference.

The outcome of this study, the STITCH trial, should come as no surprise to cardiac surgeons. They have known for a long time that coronary bypass surgery (CABG), can improve long term survival, especially if a bypass can be preformed to a “dormant” part of the heart muscle. Dormant or “hibernating” myocardium is a part of the heart that is starving for an adequate blood supply, but cannot function adequately without it.

Likewise, for the most part, medications can only reduce the work load of the heart and heart stents do not prolong life. Thus, the results of the STITCH trial may offer new hope for the two-thirds of the 6 million people in the United States with heart failure and coronary artery disease (CAD).

1): Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction, Eric J. Velazquez, M.D., et all. N Engl J Med April 4, 2011
2): Bypass Surgery Best for Some Heart Failure Patients by Steven Reinberg, HealthDay Reporter.
3): Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy, Erberto Carluccio et al. Eur Heart J (2009) 30 (12): 1501-1509.

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