title: [Effectiveness of simultaneous cardiac resynchronization therapy in surgical valvular patients with severe heart failure].
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT)has been accepted broadly as an alternative to medical treatment in managing severe heart failure patients. Despite advance in CRT, the presence of a significant valvular heart disease was currently specific exclusion criteria and a response to this therapy remains unclear. The purpose of this study was to determine the effectiveness of CRT in heart failure patients undergoing valvular operation simultaneously.
  
  
  METHODS
  Between July 2010 and May 2012, 8 heart failure patients who underwent CRT in conjunction with valvular surgery were experienced. Right and left ventricular and atrial epicardial leads were implanted after completion of valvular procedures. In patients with chronic atrial fibrillation(Af),maze procedure was performed in order to eliminate Af. To evaluate the improvement of ventricular mechanical dyssynchrony, the echocardiographic assessment was repeated on admission and 1 month after the CRT implantation.
  
  
  RESULTS
  There was no operative death. One patient of ischemic cardiomyopathy died of sustained ventricular tachycardia 2 months after the operation. Postoperative course of severe heart failure patients was uneventful and all patients except 1 discharged on foot with improved New York Heart Association (NYHA) class. Echocardiographic parameters of dyssynchrony did not reach to statistical significance, but several parameters, left ventricular( LV)-pre-ejectionperiod( PEP) and interventricular mechanical delay (IVMD) showing time delay of cardiac contraction, tended to be improve, suggesting contribution to satisfactory postoperative course.
  
  
  CONCLUSIONS
  The acceptable outcome was demonstrated with our concept to recover the intraventricular and atrioventricular synchrony. Although it might be difficult to establish the patient selection criteria for concomitant CRT and valvular surgery, our strategy is considered to be a feasible procedure to improve the morbidity and mortality in patients with severe heart failure due to valvular disease.
authors.affiliation: Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Uchida
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mizumoto
authors.forename: Cholsu
authors.initials: C
authors.lastname: Kim
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Ryota
authors.initials: R
authors.lastname: Miyazaki
authors.forename: Shuto
authors.initials: S
authors.lastname: Hirooka
authors.forename: Takumi
authors.initials: T
authors.lastname: Yasumoto
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yoshimura
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sadahiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male