Study Of The Outcome Of Minimal Access Surgical Left Ventricular Leads Placement In Cardiac Resynchronization Therapy
Sanjay Kumar1, Vladimir Shumaster2.
1Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, 2Yale New Haven Hospital, Yale University school of Medicine, New Haven, CT, USA.
Background Cardiac resynchronization therapy (CRT) using a left ventricular (LV) lead inserted via the coronary sinus (CS) improves symptoms of congestive heart failure (CHF), decreases hospitalizations, and improves survival. An epicardial LV lead is often placed surgically after failed percutaneous attempt. We studied the outcome of surgical LV lead placement after failed CS lead placement for CRT derive the same benefit as patients with a successfully placed CS lead. Methods We studied a total of 392 patients who underwent attempted CS lead insertion between June 2102 and June 2019. Forty-five patients who had failed CS lead placement and then had a minimal access surgical LV lead placed( mini thoracotomy 10, VATS 35) were matched with 145 patients who had successful CS lead placement. Results There were no major differences in preoperative variables between groups. Improvement in NYHA class (60.1% vs. 49.6%, P=0.17) was similar between surgical and percutaneous groups. Post-procedure complications of acute kidney injury (24% vs. 5.3%, P <0.001) and infection (10.5% vs. 3.2%, P=0.03) were more common in the surgical group. Mean long-term follow-up was 36.8 ± 16.5 months for surgical patients and 40.2 ± 13.9 months for percutaneous patients. At follow-up, all-cause mortality (31.6% vs. 22.4%, P=0.22) and readmission for CHF (25.8% vs. 29.7%, P=0.53) were similar between surgical and percutaneous groups. Conclusions We demonstrate that in patients with indications for biventricular pacing and failed percutaneous leads, surgical lead placement can be performed with acceptable morbidity and mortality. It confers similar functional benefits, short and long-term survival, and readmission rates for CHF compared to primary percutaneous LV lead placement. Surgical LV lead placement comes with the greater risk of perioperative complications including acute renal failure and infection.
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