Surgical placement of left ventricular lead for cardiac resynchronisation therapy after failure of percutaneous attempt

WOS: 000397242600006PubMed ID: 28262910Objective: Cardiac resynchronisation therapy has been shown to be an effective treatment to improve functional status and prolong survival of patients in advanced chronic heart failure. This study assessed the surgical outcomes of left anterior mini-thoracotomy for the implantation of left ventricular epicardial pacing leads in cardiac resynchronisation therapy. Methods: Our study consisted of 30 consecutive patients who underwent cardiac resynchronisation therapy with a left thoracotomy between November 2010 and April 2012 in our clinic. Postoperative follow up included the assessment of New York Heart Association (NYHA) functional class, electrocardiography and echocardiography. Results: There were 22 male and eight female patients with a mean age of 68 +/- 5.04 years. All patients were in NYHA class III or IV. Pre-procedure mean left ventricular ejection fraction was 28.1 +/- 4.5% and post-procedural ejection fraction improved to 31.7 +/- 5.1%. The pre-operative QRS duration changed from 171.7 +/- 10.8 to 156.2 +/- 4.4 ms after the operation. Also there was a significant reduction in left ventricular end-diastolic dimension from 6.98 +/- 0.8 to 6.72 +/- 0.8 mm (p < 0.05), but no change in left ventricular end-systolic dimension and severity of mitral regurgitation. All patients had successful surgical left ventricular lead placement. There was no procedure-related mortality. The mean follow-up time was 40.4 months. Conclusion: Surgical epicardial left ventricular lead placement procedure is a safe and effective technique in patients with a failed percutaneous attempt

Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure

WOS: 000582235000003PubMed: 33008692Introduction and Aims: the prognosis of chronic heart failure with reduced ejection fraction (HFrEF) has been studied extensively, but factors predicting cardiac decompensation are poorly defined. Right ventricular stroke work index (RVSWI), an invasive measure of right ventricular (RV) systolic function, is a well-known prognostic marker of RV failure after left ventricular assist device insertion and after lung transplantation. Thus, the aim of this study was to assess whether there is a relationship between RVSWI, HFrEF hospital readmission due to cardiac decompensation, and prognosis. Methods: We prospectively enrolled 132 consecutive patients with HFrEF. Right heart catheterization was performed and RVSWI values were calculated in all patients. the relationship between RVSWI values and readmission and prognosis was analyzed. Results: During a median follow-up of 20 +/- 7 months, 33 patients were readmitted due to cardiac decompensation in the survivor group, and 18 patients died due to cardiac causes. There was no difference between patients who died and survived in terms of RVSWI values. Among patients with decompensation, mean RVSWI was significantly lower than in patients with stable HFrEF (6.0 +/- 2.2 g/m(2)/ beat vs. 8.8 +/- 3.5 g/m(2)/ beat, p<0.001). on correlation analysis, RVSWI was negatively correlated with NYHA functional class. RVSWI was also identified as an independent risk factor for cardiac decompensation in Cox regression survival analysis. Conclusions: We showed that RVSWI predicts cardiac decompensation and correlates with functional class in advanced stage HFrEF. Our data suggest the value of combining information on right heart hemodynamics with assessment of RV function when defining the risk of patients with advanced HFrEF. (C) 2020 Published by Elsevier Espana, S.L.U. on behalf of Sociedade Portuguesa de Cardiologia

Relation of Right Ventricular Stroke Work Index with Clinical Endpoints in Patients with Advanced Heart Failure

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400246…Turkish Soc Cardio

Immediate and Follow-Up Results of Repeat Percutaneous Mitral Balloon Commissurotomy for Restenosis After a Succesful First Procedure

Background: The widespread use of percutaneous mitral commissurotomy (PMC) has led to an increase in restenosis cases. The data regarding follow-up results of repeat PMC are quite limited. The aim of this retrospective analysis is to evaluate the immediate and midterm results of the second PMC, in patients with symptomatic mitral restenosis after a succesful first procedure. Methods: Twenty patients (95% female, mean age 37 +/- 4 years) who have undergone a second PMC, 6.3 +/- 2.5 years after a first successful intervention built the study group. All were in sinus rhythm, with a mean Wilkins score of 8.5 +/- 1.2. Results: The valve area increased from 1.2 +/- 0.2 to 1.9 +/- 0.2 cm2 and mean gradient decreased from 10.5 +/- 3.4 to 6.1 +/- 1.1 mmHg. There were no complications except for a transient embolic event without sequela (5%) and two cases (10%) of severe mitral regurgitation. The immediate success rate was 90%. The mean follow-up was 70 +/- 29 months (36-156 months). The 5-year restenosis and intervention (repeat PMC or valve replacement) rates were 9.1 +/- 5.2% and 3.6 +/- 3.3%, respectively. The intervention free 5-year survival in good functional capacity (New York Heart Association [NYHA] I-II) was 95.1 +/- 5.5% and restenosis and intervention free 5-year survival with good functional capacity was 89.7 +/- 6.8%. Conclusions: Although from a limited number of selected patients, these findings indicate that repeat PMC is a safe and effective method, with follow-up results similar to a first intervention and should be considered as the first therapeutic option in suitable patients. (Echocardiography 2010;27:765-769)