Bis Jarosław, Krejca Michał, Gościńska-Bis Kinga, Szmagała Przemysław, Ulczok Rafał, Bochenek Andrzej, Kargul Włodzimierz
I Klinika Kardiochirurgii, ul. Ziolowa 47, 40-635 Katowice.
Kardiol Pol. 2007 Feb;65(2):160-4; discussion 165.
Systolic dyssynchrony as an indication for cardiac re-synchronization therapy is present in a considerable subset of patients with congestive heart failure undergoing surgical coronary revascularisation. Coronary artery bypass grafting offers an optimal setting for totally epicardial cardiac re-synchronization system implantation.
To assess the feasibility and safety of totally epicardial cardiac re-synchronization system implantation in patients with ischaemic heart disease and heart failure undergoing coronary artery bypass grafting.
Three male patients with coronary artery disease and postinfarction functional class III congestive heart failure underwent a combined procedure of on-pump surgical coronary revascularisation and totally epicardial cardiac re-synchronization system implantation (all three leads implanted epicardially). In all patients intraventricular dyssynchrony was revealed in preoperative echocardiography.
There was no perioperative morbidity or mortality. The mean total time required for cardiac re-synchronization system implantation was 17.3+/-2.3 minutes. We obtained excellent pacing and sensing parameters at implant (left ventricular pacing thresholds: 0.8, 0.5, 0.5 V at 0.5 ms; left ventricular sensing thresholds: 17, 15, 20 mV, respectively in consecutive patients). After 12 months pacing and sensing parameters remained stable. Significant improvement in 6-minute walk test distance, functional class and echocardiographic parameters (left ventricular ejection fraction, intraventricular dyssynchrony) was observed in all patients.
Totally epicardial cardiac re-synchronization system implantation is safe and can be regarded as an important supplement to surgical coronary revascularisation in the still growing population of patients with severe heart failure and systolic dyssynchrony, which can be used for the optimisation of treatment results.
收缩期不同步作为心脏再同步治疗的指征，在相当一部分接受外科冠状动脉血运重建的充血性心力衰竭患者中存在。冠状动脉旁路移植术为完全心外膜心脏再同步系统植入提供了理想环境。
评估在接受冠状动脉旁路移植术的缺血性心脏病和心力衰竭患者中，完全心外膜心脏再同步系统植入的可行性和安全性。
3例患有冠状动脉疾病且心肌梗死后心功能Ⅲ级充血性心力衰竭的男性患者接受了体外循环下外科冠状动脉血运重建和完全心外膜心脏再同步系统植入的联合手术（所有三根导线均在心外膜植入）。所有患者术前超声心动图均显示存在心室内不同步。
围手术期无 morbidity 或死亡率。心脏再同步系统植入所需的平均总时间为17.3±2.3分钟。植入时我们获得了极佳的起搏和感知参数（左心室起搏阈值：在0.5毫秒时分别为0.8、0.5、0.5伏；左心室感知阈值：连续患者分别为17、15、20毫伏）。12个月后起搏和感知参数保持稳定。所有患者在6分钟步行试验距离、心功能分级和超声心动图参数（左心室射血分数、心室内不同步）方面均有显著改善。
完全心外膜心脏再同步系统植入是安全的，可被视为在仍在增加的严重心力衰竭和收缩期不同步患者群体中，对外科冠状动脉血运重建的重要补充，可用于优化治疗效果。
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