Efficacy of Cardiac Resynchronization Therapy Performed Concomitantly with Primary Cardiac Surgery

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Cardiac resynchronization therapy (CRT) improves symptoms and cardiac function in patients with heart failure and prolongs QRS duration on an electrocardiogram. However, additional effects of concomitant CRT in patients who undergo cardiac surgery are unclear. We assessed the clinical efficacy of this therapy when it is performed concomitantly with primary cardiac surgery.<BR>METHODS: We evaluated four patients who underwent primary surgery and CRT between February 2002 and December 2003, and compare clinical data with four patients who underwent conventional primary surgery without CRT.<BR>RESULTS: Primary surgeries were CABG (n=2), aortic valve replacement (n=1), mitral valve plasty (n=1) and mitral annular plication (n=4). After the operation, symptoms associated with congestive heart failure were improved in all patients. The average NYHA class improvement was from 3.3±0.5 before the operation to 1.7±0.6 after the operation. All patients were discharged after surgery. Only one patient needed re-hospitalization for congestive heart failure one month after the operation. The mean QRS duration (190±47.6 ms vs 160±16.3 ms), cardiothoracic ratio (60.7±5.7% vs 58.5±2.9%) and ejection fraction (28.5±8.8% vs 50.0±0.0%) were also improved after surgery.<BR>CONCLUSION: In patients with poor left ventricular function and impaired cardiac conduction, CRT performed concomitantly with primary surgery may improve the postoperative course. Further study on indications for implantation of a CRT device during primary surgery is needed.

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