Straka Frantisek, Pirk Jan, Pindak Marian, Skalsky Ivo, Vancura Vlastimil, Cihak Robert, Marek Tomas, Lupinek Petr, Masin Jaroslav, Schornik David, Zeman Michal, Skrobakova Janka, Dorazilova Zora, Skibova Jelena
Department of Cardiovascular Surgery Department of Anaesthesiology and Intensive Care Medicine Department of Cardiology Medical Statistics Unit, Institute for Clinical and Experimental Medicine, Videnska, Prague, Czech Republic Medtronic Czechia s.r.o., Revnicka, Prague, Czech Republic.
Pacing Clin Electrophysiol. 2011 Oct;34(10):1231-40. doi: 10.1111/j.1540-8159.2011.03161.x. Epub 2011 Jun 30.
Congestive heart failure negatively impacts the prognosis in patients after cardiac surgery. The aim of our study was to assess the value of targeted cardiac resynchronization therapy (CRT) within 72 hours after cardiac surgery in patients with mechanical dyssynchrony, who had an ejection fraction ≤ 35%, QRS ≥150 ms or between 120 and 150 ms.
A prospective randomized trial based on three-dimensional echocardiography (RT3DE) and optimized sequential dual-chamber (DDD ) pacing in patients after cardiac surgery. DDD epicardial pacing (Medtronic coaxial epicardial leads 6495) was provided by a modified Medtronic INSYNC III Pacemaker (Medtronic Inc., Minneapolis, MN, USA).
The study included 21 patients with ischemic heart disease (HD) or valvular HD (16 men, 5 women, average age 69 years) with left ventricle (LV) dysfunction after cardiac surgery . Patients with biventricular (BIV) (CO 6.7 ± 1.7 L/min, CI 3.5 ± 0.8 L/min/m(2) ) and LV (CO 6.2 ± 1.5 L/min, CI 3.2 ± 0.7 L/min/m(2) ) pacing had statistically significantly higher CO and CI than patients with right ventricular (RV) (CO 5.4 ± 1.4 L/min, CI 2.8 ± 0.6 L/min/m(2) ) pacing (BIV vs RV P ≤ 0.001; LV vs RV P ≤ 0.05; BIV vs LV P ≤ 0.05).
RT3DE targeted and optimized CRT in the early postperative period after cardiac surgery provided better hemodynamic results than RV pacing.
充血性心力衰竭对心脏手术后患者的预后产生负面影响。我们研究的目的是评估在心脏手术后72小时内，对存在机械性不同步、射血分数≤35%、QRS≥150毫秒或在120至150毫秒之间的患者进行靶向心脏再同步治疗（CRT）的价值。
一项基于三维超声心动图（RT3DE）并在心脏手术后患者中进行优化顺序双腔（DDD）起搏的前瞻性随机试验。DDD心外膜起搏（美敦力同轴心外膜导线6495）由改良的美敦力INSYNC III起搏器（美敦力公司，明尼阿波利斯，明尼苏达州，美国）提供。
该研究纳入了21例患有缺血性心脏病（HD）或瓣膜性HD的患者（16例男性，5例女性，平均年龄69岁），这些患者在心脏手术后存在左心室（LV）功能障碍。双心室（BIV）起搏（心输出量[CO]6.7±1.7升/分钟，心脏指数[CI]3.5±0.8升/分钟/平方米）和LV起搏（CO 6.2±1.5升/分钟，CI 3.2±0.7升/分钟/平方米）的患者，其CO和CI在统计学上显著高于右心室（RV）起搏的患者（CO 5.4±1.4升/分钟，CI 2.8±0.6升/分钟/平方米）（BIV与RV相比P≤0.001；LV与RV相比P≤0.05；BIV与LV相比P≤0.05）。
心脏手术后早期，RT3DE靶向并优化的CRT比RV起搏提供了更好的血流动力学结果。
