Tanaka Hiroyuki, Okishige Kaoru, Mizuno Tomohiro, Kuriu Kazuyuki, Itoh Fusahiko, Shimizu Masato, Akamatsu Hideki, Tabuchi Noriyuki, Arai Hirokuni, Sunamori Makoto
Department of Thoracic and Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan.
Jpn J Thorac Cardiovasc Surg. 2002 Jul;50(7):284-9. doi: 10.1007/BF03032296.
Biventricular pacing (BVP) is a new strategy for treating patients with severe congestive heart failure (CHF) and intraventricular conduction delay, but its full potential and technicalities of BVP require further evaluation. We evaluated BVP benefits in 4 patients in whom we implanted a left ventricular lead during primary cardiac surgery.
Four CHF patients treated surgically between October 2000 and August 2001 underwent, at primary surgery, the implantation of leads in the right atrium, right ventricle, and left ventricle (LV) for postsurgical BVP. All patients had severe LV dysfunction and dilatation with intraventricular conduction delay. Surgeries involved CABG alone (n = 1), CABG + Dor's operation (n = 2), and tricuspid valve replacement + Maze procedure (n = 1). BVP was begun immediately after surgery in all 4 patients. Hemodynamic variables with BVP were compared to those without BVP for each patient, and the utility and technical aspects of implantation were evaluated.
BVP increased mean systemic blood pressure by 11% and mean LV stroke work index by 19% in the acute postsurgery period, and reduced mitral regurgitation. Two of the patients were implanted with a generator for permanent BVP, one at 1 month and the other at 6 months after surgery. The threshold of the LV epicardial lead of these 2 patients was below 2 V during follow-up, and BVP was successful.
Temporary BVP during the short-term after cardiac surgery improved cardiac function and decreased mitral regurgitation in all 4 of our patients. Epicardial lead implantation may thus be a useful option during surgical treatment of patients with CHF and intraventricular conduction delay if long-term permanent BVP is indicated.
双心室起搏（BVP）是治疗重度充血性心力衰竭（CHF）合并室内传导延迟患者的一种新策略，但其全部潜力和技术细节仍需进一步评估。我们评估了4例在心脏初次手术期间植入左心室导线的患者接受BVP的益处。
2000年10月至2001年8月期间接受手术治疗的4例CHF患者在初次手术时，于右心房、右心室和左心室（LV）植入导线，以便术后进行BVP。所有患者均有严重的左心室功能障碍和扩张，并伴有室内传导延迟。手术包括单纯冠状动脉旁路移植术（CABG，n = 1）、CABG + Dor手术（n = 2）以及三尖瓣置换术 + 迷宫手术（n = 1）。所有4例患者术后均立即开始BVP。比较了每位患者有BVP和无BVP时的血流动力学变量，并评估了植入的实用性和技术方面。
在术后急性期，BVP使平均体循环血压升高了11%，左心室平均每搏功指数升高了19%，并减少了二尖瓣反流。其中2例患者植入了用于永久性BVP的发生器，1例在术后1个月植入，另1例在术后6个月植入。随访期间，这2例患者的左心室心外膜导线阈值低于2V，BVP成功。
心脏手术后短期内进行临时BVP改善了我们所有4例患者的心功能并减少了二尖瓣反流。因此，如果需要长期永久性BVP，在心外膜导线植入可能是CHF合并室内传导延迟患者手术治疗期间的一个有用选择。
