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Surgery Superior to Medical Therapy for Severe Heart Disease

Surgery Superior to Medical Therapy for Severe Heart Disease—Heart attacks and coronary artery disease produce a reduction in blood flow (ischemia) to the left ventricle (the heart’s main pumping chamber), making it enlarged and weak (cardiomyopathy)—an often-lethal condition called ischemic cardiomyopathy. In a major study published in April, in the New England Journal of Medicine, investigators found that coronary artery bypass grafting (CABG) offers a significant survival advantage over medical therapy alone to patients with ischemic cardiomyopathy. One of the study’s chief investigators was Robert Michler, M.D. The study enrolled more than 1,200 patients who were randomly assigned to one of the two treatment groups. After a median follow-up period of nearly 10 years, 66.1 percent of patients in the medical-therapy group had died compared to 58.9 percent of patients in the CABG treatment group—a statistically significant (p=0.02) difference. Dr. Michler is professor and chair of surgery and of cardiovascular & thoracic surgery at Einstein, surgeon-in-chief at Montefiore and co-director of the Montefiore Einstein Center for Heart and Vascular Care.

Wednesday, May 18, 2016

Treating Atrial Fibrillation — Atrial fibrillation (AF) is a condition that produces rapid and irregular heartbeats, and increases the risk for stroke and death. Treatments for AF include medical therapy, cardiac catheterization ablation or surgery.  Ablation and surgery scar areas of heart tissue and can cure AF. Many AF patients in need of heart valve surgery may benefit from an AF procedure to eliminate AF. To find out, 20 centers in the NIH-sponsored Cardiothoracic Surgical Trials Network enrolled 260 AF patients who also needed mitral-valve surgery.  (Up to half of people needing mitral-valve surgery also have AF.) Results were published in the March 16 issue of the New England Journal of Medicine. Study coauthor, Dr. Robert Michler is a principal investigator on this prestigious NIH award. He and coauthor Dr. Joseph DeRose, Jr., of Montefiore Medical Center—Einstein’s University Hospital and academic medical center—and surgeons at other participating centers enrolled the patients to randomly undergo surgical ablation or no ablation (control group). Ablation patients were further randomized to one of two types of ablation. All patients were assessed 6 and 12 months after surgery. Significantly more patients in the ablation group than in the control group were free of AF at both 6 and 12 months (63.2 percent vs. 29.4%). While the two types of ablation proved equally effective, patients who underwent ablation were significantly more likely than control patients to require implantation of a permanent pacemaker. Dr. Michler is professor and chair of cardiovascular and thoracic surgery and of surgery. Dr. DeRose is associate professor of cardiovascular and thoracic surgery.

Tuesday, September 22, 2015
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