Coronary artery bypass grafting with and without concomitant epicardial cardiac resynchronization therapy in patients with ischemic cardiomyopathy: a randomized study.
BACKGROUND
Epicardial implantation of a cardiac resynchronization therapy (CRT) system during coronary artery bypass grafting (CABG) may be an additional treatment method for improving left ventricle (LV) systolic function and dyssynchrony in patients with ischemic heart failure.


OBJECTIVE
The objective was to compare the long-term results in patients with severe ischemic heart failure who underwent CABG alone or CABG combined with concomitant epicardial implantation of a CRT system.


METHODS
One hundred sixty-four consecutive patients with severe ischemic heart failure and LV dyssynchrony were enrolled into 2 groups: CABG alone (n = 80) and epicardial CRT implantation during CABG (CABG + CRT) (n = 84). This prospective, randomized, and single-blind study was designed to compare clinical and echocardiography data after 6, 12, and 18 months of follow-up.


RESULTS
In the CABG group, LV systolic function, dyssynchrony signs, and quality of life did not change postoperatively, compared with preoperative data. In contrast, these parameters significantly improved in the CABG + CRT group. The 2 treatment groups did not differ with respect to postoperative improvement in Canadian Cardiovascular Society class (P = .68). The improvement in the New York Heart Association functional class was much more pronounced in the CABG + CRT group than in the CABG group (P = .029). In the CABG group, 21 patients (26.2%) had died by the 18-month follow-up, compared with 9 patients (10.7%) in the CABG + CRT group (P = .012, log-rank test).


CONCLUSIONS
Epicardial implantation of a CRT system concomitantly with CABG facilitates the early postoperative period, improves LV systolic function, improves the quality of life, and decreases LV dyssynchrony. Moreover, mortality in the CABG + CRT group was significantly lower than in the CABG group.
Pokushalov
Evgueny
E
State Research Institute of Circulation Pathology, Novosibirsk, Russia. E.Pokushalov@gmail.com
Romanov
Alexander
A
Prohorova
Darya
D
Cherniavsky
Alexander
A
Karaskov
Alexander
A
Gersak
Borut
B
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006305:Health Status Indicators; D006352:Heart Ventricles; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D010496:Pericardium; D016037:Single-Blind Method; D017524:Slovenia; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left