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
