Cardiac resynchronization therapy as an adjunct to conventional surgical treatment for heart failure

From March 2004 through October 2007, we prospectively evaluated the benefits of cardiac resynchronization therapy as an adjunct to conventional procedures in patients who were undergoing surgery for heart failure.Twenty severely symptomatic patients (14 men and 6 women, with a mean age of 70 +/- 8 years) who displayed advanced cardiomyopathy, QRS duration > or =130 ms, or mechanical dyssynchrony, underwent isolated or combined coronary artery revascularization and mitral valve overreduction. In all patients, an epicardial lead was secured to the left ventricular wall at the end of the procedure and its extremity was brought into a subclavian pocket. In 5 patients, a resynchronization device was implanted at the time of surgery; in 8, it was implanted at a later date; the remaining 7 patients are awaiting implantation. One patient died postoperatively of low-output syndrome. There was 1 noncardiac late death. Eighteen patients were alive at a mean postoperative follow-up of 21.6 +/- 15.2 months (range, 1-43 mo). There were no subsequent hospital admissions after discharge. New York Heart Association functional class and left ventricular performance were significantly and lastingly improved when cardiac resynchronization therapy was added to the surgical procedure. Despite the limitations inherent in the small number of patients and the relatively short duration of follow-up, this study suggests that patients with dilated cardiomyopathy and left ventricular dyssynchrony in whom surgical correction is indicated may benefit from cardiac resynchronization therapy using a resynchronization device connected to an epicardial lead secured to the left ventricle at the time of surgery.