An operation that once looked promising to treat heart failure has turned out not to help patients, doctors are reporting.
The operation, ventricular reconstruction, reshapes the heart’s main pumping chamber in the hopes of making it work better.
For about 20 years, surgeons have been performing it on some patients with heart failure who are already undergoing bypass surgery to treat blocked coronary arteries.
About five million Americans have heart failure, and it contributes to 287,000 deaths a year. Causes include damage from heart attacks, blocked coronary arteries, diseased heart valves, high blood pressure and diabetes.
As a result, the heart becomes enlarged, scarred, misshapen and too weak to pump enough blood. Patients can become short of breath and have trouble walking.
Doctors had hoped that reconstruction, by restoring the heart’s natural shape and size, would help people feel better and survive longer.
But it does not, according to a major study in which 1,000 people were randomly assigned to have either reconstruction as well as bypass surgery, or bypass alone.
Researchers then tracked the patients for a median of 48 months to see how many died or wound up in the hospital again.
They also looked at symptoms and ability to exercise.
There were no differences between the two groups.
Death and rehospitalization rates were the same, and symptoms improved equally in both groups. But the patients who had the reconstruction spent more time on the operating table and in the hospital.
Some surgeons say patients with severe scars on the heart, who were not studied, may benefit from the surgery.
But performing the operation routinely “cannot be justified,” wrote Dr. Howard J. Eisen, in an editorial published online Friday in The New England Journal of Medicine. Dr. Eisen, who did not take part in the study, is a cardiologist at the Drexel University medical school in Philadelphia.
