Is Ventricular reshaping surgery back: CONFIGURE-HF stitched ventricle better than STICHED trial.

In STICHED trial benefit of ventricular reshaping surgery in heart failure along with CABG did not show benefit than just CABG. But CONFIGURE –HF Phase -1 trial presented recently in Heart Failure Congress 2013 showed benefit of ventricular reshaping surgery.

Treatment of heart failure has progressed remarkably but still these patients do have big sized heart, bigger the heart more the after load and more likely it dilates further, and fails early and contributes to worsening morbidity and mortality.

STICHED trial which was published before did not give any benefit in terms of angina reduction, heart-failure symptoms, the six-minute-walk test, or clinical outcomes, including death and hospitalization.
In case of CONFIGURE-HF phase 1trial, where ventricular reshaping surgery was performed and has shown benefit in terms of at 6 to 12 months follow-up in terms of ventricular volume reduction and also in terms of six-minute-walk test, NYHA class, and quality of life.

The benefit of CONFIGURE-HF   trial over STICH trial may be from the amount of volume reduction achieved in these trials. In STICH trial Systolic volume reduced was by 19% versus 33% in CONFIGURE-HF.

In CONFIGURE-HF trial, surgery was done with titaniumanchors (Revivent, BioVentrix) to pull and exclude scarred and not contracting muscle from the contracting ventricular chamber. In CONFIGURE-HF   trial surgical reconstruction was done in patients with myocardial scarring in the anteroseptal region and also apex of the heart. In this trial, Surgeons placed an anchor in the right ventricle, along the septal juncture, and a second anchor at the external end of the myocardial scar. The two anchors are drawn together in order to plicate the scar tissue, and ellipsoid geometry of the heart was restored.

CONFIGURE-HF phase 1 trial contained just 26 patients with NYHA two and three patients with equal number and this small number the benefit were achieved, this needs further confirmation by larger trial. 

Author: Dr Umesh Bilagi

MBBS, MD, DM (cardiology). I am Interventional cardiologist. Blogging is my passion. Associate professor of cardiology KIMS Hubli. Director and consultant at Tatwadarsha Hospital Hubli. Owner of Jeevan Jyoti Hospital Hubli. Mobile +91 9343403620.

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