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Heart-folding operation has no benefit for most
Source: Agencies |
March 31, 2009, Tuesday
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Print Edition
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A CONTROVERSIAL operation that folds the scarred portion of a damaged heart in on itself to get it to beat more effectively offers no real benefit to most patients, researchers reported on Sunday.
The operation, known as ventricular reconstruction, is designed to help people with heart failure - a condition that affects about 5 million in the United States alone and often occurs after tissue is damaged by a heart attack.
Generally, the heart tries to compensate for the damage by getting larger, but it also pumps far less efficiently.
Doctors in a trial compared what happened to 1,000 volunteers, who all got heart bypass operations. Half also got ventricular reconstruction.
Ventricular reconstruction did nothing to reduce the death rate or the risk of going back to the hospital. Nor did it improve the quality of life after four years, the researchers told a meeting of the American College of Cardiology in Orlando.
"It doesn't seem to have any great benefit at all," said Dr Robert Jones of Duke University Medical Center in North Carolina. With the surgery, "many patients have a lot fewer symptoms, but some people improve that much with good medical treatment."
Not doing the reconstruction will save an average of US$14,595 in hospital costs per patient, and patients will spend one half hour less in the operating room.
Dr Robert Michler of the Montefiore-Einstein Heart Center in New York City said the operation is seldom done in the US, and estimated that 3,000 to 5,000 such procedures have been done worldwide in the past 10 years.
"There are a lot of evangelists for this operation," but others have seen in practice that it adds little benefit, Jones said. "I think those guys have figured out on their own that it's not a whole lot better."
Michler said further studies will show whether there are still some patients who might benefit from the operation, which reduces the size of an enlarged heart by 20 percent.
Dr Howard Eisen of Drexel University College of Medicine in Philadelphia said that surgically reducing the size of the heart is different from shrinking it with conventional heart-failure therapies.
The operation, known as ventricular reconstruction, is designed to help people with heart failure - a condition that affects about 5 million in the United States alone and often occurs after tissue is damaged by a heart attack.
Generally, the heart tries to compensate for the damage by getting larger, but it also pumps far less efficiently.
Doctors in a trial compared what happened to 1,000 volunteers, who all got heart bypass operations. Half also got ventricular reconstruction.
Ventricular reconstruction did nothing to reduce the death rate or the risk of going back to the hospital. Nor did it improve the quality of life after four years, the researchers told a meeting of the American College of Cardiology in Orlando.
"It doesn't seem to have any great benefit at all," said Dr Robert Jones of Duke University Medical Center in North Carolina. With the surgery, "many patients have a lot fewer symptoms, but some people improve that much with good medical treatment."
Not doing the reconstruction will save an average of US$14,595 in hospital costs per patient, and patients will spend one half hour less in the operating room.
Dr Robert Michler of the Montefiore-Einstein Heart Center in New York City said the operation is seldom done in the US, and estimated that 3,000 to 5,000 such procedures have been done worldwide in the past 10 years.
"There are a lot of evangelists for this operation," but others have seen in practice that it adds little benefit, Jones said. "I think those guys have figured out on their own that it's not a whole lot better."
Michler said further studies will show whether there are still some patients who might benefit from the operation, which reduces the size of an enlarged heart by 20 percent.
Dr Howard Eisen of Drexel University College of Medicine in Philadelphia said that surgically reducing the size of the heart is different from shrinking it with conventional heart-failure therapies.
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