Does Prior Valve Surgery Change Outcome in Patients Treated with Cardiac Resynchronization Therapy?

作者：Bose Abhishek; Upadhyay Gaurav A^*; Kandala Jagdesh; Heist Edwin K; Mela Theofanie; Parks Kimberly A; Singh Jagmeet P

来源：Journal of Cardiovascular Electrophysiology, 2014, 25(11): 1206-1213.

DOI：10.1111/jce.12469

• coronary artery bypass surgery
• cardiac resynchronization therapy
• cardiac valve surgery
• heart failure
• heart transplant

Impact of Prior Valve Surgery in CRT Patients
AimsCardiac valve surgery (CVS) has been implicated as a potential barrier to optimal response after cardiac resynchronization therapy (CRT) though prospective data regarding outcome remains limited. We sought to determine CRT response in patients with a prior history of CVS.
Methods and ResultsWe performed a retrospective analysis of a prospectively acquired cohort of CRT patients with history of CVS. Echocardiographic response was evaluated at baseline and 6 months. The coprimary endpoints were time to first heart failure (HF) hospitalization and a composite of all-cause mortality, transplantation and left ventricular assist device (LVAD) assessed over a 3-year follow-up period. The study group consisted of 569 patients undergoing CRT. Of these, 86 patients had a history of CVS (46.5% aortic, 37.2% mitral, 16.3% combined, and tricuspid), and were compared to 483 patients with no history of CVS. Baseline clinical and echocardiographic characteristics were not significantly different between the groups except for a higher incidence of atrial fibrillation (AF; 74.4% vs. 55.3%; P = 0.001), coronary artery bypass surgery (CABG; 58.1% vs. 38.7%; P = 0.001), and longer QRS duration (167.6 29.3 milliseconds vs. 159.4 +/- 27.5 milliseconds; P = 0.01) in those with prior CVS. Survival with respect to HF hospitalization and composite outcome was comparable in both groups. Echocardiographic response (improvement in left ventricular ejection fraction of 10%) was similar. No difference in clinical or echocardiographic outcome was found by type of valve surgery performed.
ConclusionDespite a higher incidence of AF, CABG, and longer QRS duration, history of CVS is not associated with worse clinical or echocardiographic outcome after CRT.

• 出版日期2014-11