title: Cardiac resynchronization therapy in patients undergoing open-chest cardiac surgery.
abstract: OBJECTIVE
  Few data are available on the effects of cardiac resynchronization therapy (CRT) in candidates for cardiac surgery and affected by severe heart failure (HF). The aim of our analysis is to evaluate the percentage of patients who maintain indication for CRT after surgery and the efficacy of CRT in those patients subsequently implanted.
  
  
  METHODS
  We enrolled 124 HF patients with indication both to heart surgery and to CRT. During surgery, an epicardial left ventricular lead was implanted, tunneled to a subclavear pocket, and capped. Afterward, patients were periodically reassessed to confirm indication for CRT.
  
  
  RESULTS
  CRT indication was confirmed within 1 month from surgery in 54 patients (group A) and in 33 patients within 6 months (group B). In group A and B, 63% and 71% of patients were considered responders according to an arbitrary five-point increase of left ventricular ejection fraction (LVEF), respectively. The assessment of clinical response at 1 year, based on the definitions proposed by Packer, identified 63% and 80% of responders in group A and B, respectively.
  
  
  CONCLUSIONS
  Our data show that a remarkable percentage of patients maintain an indication for CRT after cardiac surgery (76%), while in the remaining 24% the lack of an indication is confirmed by a higher LVEF at last follow-up. In combination with surgery, CRT proved to be an effective therapy in those patients who were subsequently implanted. The suggested method is simple, without significant adjunctive risks, and allows easier CRT implantation with stable thresholds.
authors.affiliation: Division of Cardiac Surgery, Niguarda Ca'Granda Hospital, Milan, Italy. alberto.barosi@alice.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Barosi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Speca
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzola
authors.forename: Gabriele
authors.initials: G
authors.lastname: Paglino
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Saverio
authors.initials: S
authors.lastname: Iacopino
authors.forename: Mauro
authors.initials: M
authors.lastname: Cassese
authors.forename: Cosimo Damiano
authors.initials: CD
authors.lastname: Dicandia
authors.forename: Giampiero
authors.initials: G
authors.lastname: Esposito
authors.forename: Marco
authors.initials: M
authors.lastname: Vimercati
authors.forename: Alberto
authors.initials: A
authors.lastname: Della Scala
authors.forename: Ettore
authors.initials: E
authors.lastname: Vitali
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000191:economics; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D018709:Statistics, Nonparametric; D016896:Treatment Outcome