Coronary Artery Bypass Grafting with and without Concomitant Epicardial Cardiac Resynchronization Th erapy in Patients with Ischemic Cardiomyopathy: A Randomized Study
DOI:
https://doi.org/10.1532/HSF98.20091149Abstract
Background: Epicardial implantation of a cardiac resynchronization therapy (CRT) system during coronary artery bypass grafting (CABG) may be an additional treatment method for improving left ventricle (LV) systolic function and dyssynchrony in patients with ischemic heart failure.
Objective: The objective was to compare the long-term results in patients with severe ischemic heart failure who underwent CABG alone or CABG combined with concomitant epicardial implantation of a CRT system.
Methods: One hundred sixty-four consecutive patients with severe ischemic heart failure and LV dyssynchrony were enrolled into 2 groups: CABG alone (n = 80) and epicardial CRT implantation during CABG (CABG + CRT) (n = 84). This prospective, randomized, and single-blind study was designed to compare clinical and echocardiography data after 6, 12, and 18 months of follow-up.
Results: In the CABG group, LV systolic function, dyssynchrony signs, and quality of life did not change postoperatively, compared with preoperative data. In contrast, these parameters significantly improved in the CABG + CRT group. The 2 treatment groups did not differ with respect to postoperative improvement in Canadian Cardiovascular Society class (P = .68). The improvement in the New York Heart Association functional class was much more pronounced in the CABG + CRT group than in the CABG group (P = .029). In the CABG group, 21 patients (26.2%) had died by the 18-month follow-up, compared with 9 patients (10.7%) in the CABG + CRT group (P = .012, log-rank test).
Conclusion: Epicardial implantation of a CRT system concomitantly with CABG facilitates the early postoperative period, improves LV systolic function, improves the quality of life, and decreases LV dyssynchrony. Moreover, mortality in the CABG + CRT group was significantly lower than in the CABG group.
References
Abraham WT, Fisher WG, Smith AL, et al, for the MIRACLE Study Group. 2002. Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845-53.nBax J, Abraham T, Barold S, et al. 2005. Cardiac resynchronization therapy: part 1—issues before device implantation. J Am Coll Cardiol 46:2153-67.nBax JJ, Ansalone G, Breithardt OA, et al. 2004. Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use? J Am Coll Cardiol 44:1-9.nBax JJ, Bleeker GB, Marwick TH, et al. 2004. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 44:1834-40.nBax JJ, Van der Wall EE, Schalij MJ. 2002. Cardiac resynchronization therapy for heart failure. N Engl J Med 347:1803-4.nBis J, Krejca M, Goscinska-Bis K, Ulczok R, Szmagala P, Bochenek A. 2007. Totally epicardial cardiac re-synchronization therapy system implantation in patients with heart failure undergoing CABG: description of 3 cases. Kardiol Pol 65:160-4.nBradley DJ, Bradley EA, Baughman KL, et al. 2003. Cardiac resynchronization and death from progressive heart failure: a metaanalysis of randomized controlled trials. JAMA 289:730-40.nChung ES, Leon AR, Tavazzi L, et al. 2008. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation 117:2608-16.nCleland J, Daubert JC, Erdmann E, et al. 2005. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539-49.nEagle KA, Guyton RA, Davidoff R, et al; American College of Cardiology; American Heart Association. 2004. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 110:e340-437.nEllenbogen KA, Wood MA, Klein HU. 2005. Why should we care about CARE-HF? J Am Coll Cardiol 46:2199-204.nGoscinska-Bis K, Bis J, Krejca M, et al. 2008. Totally epicardial cardiac resynchronization therapy system implantation in patients with heart failure undergoing CABG. Eur J Heart Fail 10:498-506.nKaesemeyer WH. 1994. Holding smokers Accountable for heart disease costs. Circulation 90:1029-32.nMair H, Sachweh J, Meuris B, et al. 2005. Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing. Eur J Cardiothorac Surg 27:235-42.nMizuno T, Tanaka H, Makita S, Tabuchi N, Arai H, Sunamori M. 2003. Biventricular pacing with coronary bypass and Dor's ventriculoplasty. Ann Thorac Surg 75:998-9.nNavia JL, Atik FA. 2005. Minimally invasive left ventricular epicardial lead placement: surgical techniques. Ann Thorac Surg 79:1536-44.nSteendijk P, Tulner SA, Schreuder JJ, et al. 2004. Quantification of left ventricular mechanical dyssynchrony by conductance catheter in heart failure patients. Am J Physiol Heart Circ Physiol 286:H723-30.nVan de Veire NR, Bleeker GB, De Sutter J, et al. 2007. Tissue synchronisation imaging accurately measures left ventricular dyssynchrony and predicts response to cardiac resynchronisation therapy. Heart 93:1034-39.nVelazquez EJ, Lee KL, O'Connor CM, et al. 2007. The rationale and design of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. J Thorac Cardiovasc Surg 134:1540-7.n
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).
