Abstract
PurposeCardiac resynchronization therapy (CRT) is an established therapeutic option in selected heart failure patients (pts). However, the transvenous left ventricular (LV) lead implantation remains ineffectual in a considerable number of pts. Transapical LV (TALV) lead implantation is an alternative minimally invasive, surgical, endocardial implantation technique. The aim of the present prospective study is to determine the long-term outcome, including the cerebral thromboembolic complications, of pts who underwent TALV lead placement.MethodsTwenty-six CRT candidates (19 men (78 %); mean age 61 ± 10 years) with a previously failed transvenous approach underwent TALV lead placement as a last resort therapy. The following data was collected: mortality rate, reoperation rate, and cerebrovascular event rate. Patients underwent a cerebral CT scan to determine any possible cerebrovascular event related to the presence of the TALV lead.ResultsEleven out of 26 (47 %) patients survived after a median follow-up of 40 ± 24.5 months. Major acute ischemic stroke occurred in two cases, while in one case transient ischemic stroke was observed. Cerebral CT scan examination performed in asymptomatic patients revealed chronic ischemic lesions with minimal extension in two patients. Reoperation occurred in one case due to TALV lead fracture.ConclusionsThis is the first study reporting the long-term outcome, mortality, and thromboembolic event rate exclusively after TALV lead implantation. Patients who underwent TALV lead implantation have a comparable long-term mortality rate to conventional CRT, although a major ischemic cerebrovascular event after TALV lead implantation is worrisome and has an impact on the outcome.
Highlights
Cardiac resynchronization therapy (CRT) is an established therapeutic option in a subgroup of heart failure patients, which improves heart function and functional clinical status and decreases mortality [1,2,3]
A third patient was admitted to our hospital 1 month after the transapical CRT implantation with symptoms of pericardial tamponade, caused by the dislocation of the transapical left ventricular (TALV) lead
The major finding of this study is that, transapical CRT can be used as an alternative method for CRT in selected heart failure patients, it represents a worrisome thromboembolic complication rate compared to traditional transvenous CRT
Summary
Cardiac resynchronization therapy (CRT) is an established therapeutic option in a subgroup of heart failure patients, which improves heart function and functional clinical status and decreases mortality [1,2,3]. The transvenous left ventricular (LV) pacing lead implantation into one of the branches of the coronary sinus (CS) can remain ineffectual in certain cases [4, 5]. Transseptal cardiac resynchronization therapy carries a high risk of device-related infective endocarditis. This condition can only be treated by hazardous surgical lead extraction and repair or replacement of the mitral valve when affected [8, 9]. The main advantages of the transapical technique are the following: a minimally invasive, surgical technique ensuring endocardial LV stimulation, avoiding damage caused by contact with the mitral valve, which provides an alternative last resort therapy for severely affected patients [8, 9]
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