title: Does prior valve surgery change outcome in patients treated with cardiac resynchronization therapy?
abstract: OBJECTIVE
  Cardiac valve surgery (CVS) has been implicated as a potential barrier to optimal response after cardiac resynchronization therapy (CRT) though prospective data regarding outcome remains limited. We sought to determine CRT response in patients with a prior history of CVS.
  
  
  RESULTS
  We performed a retrospective analysis of a prospectively acquired cohort of CRT patients with history of CVS. Echocardiographic response was evaluated at baseline and 6 months. The coprimary endpoints were time to first heart failure (HF) hospitalization and a composite of all-cause mortality, transplantation and left ventricular assist device (LVAD) assessed over a 3-year follow-up period. The study group consisted of 569 patients undergoing CRT. Of these, 86 patients had a history of CVS (46.5% aortic, 37.2% mitral, 16.3% combined, and tricuspid), and were compared to 483 patients with no history of CVS. Baseline clinical and echocardiographic characteristics were not significantly different between the groups except for a higher incidence of atrial fibrillation (AF; 74.4% vs. 55.3%; P = 0.001), coronary artery bypass surgery (CABG; 58.1% vs. 38.7%; P = 0.001), and longer QRS duration (167.6 ± 29.3 milliseconds vs. 159.4 ± 27.5 milliseconds; P = 0.01) in those with prior CVS. Survival with respect to HF hospitalization and composite outcome was comparable in both groups. Echocardiographic response (improvement in left ventricular ejection fraction of ≥10%) was similar. No difference in clinical or echocardiographic outcome was found by type of valve surgery performed.
  
  
  CONCLUSIONS
  Despite a higher incidence of AF, CABG, and longer QRS duration, history of CVS is not associated with worse clinical or echocardiographic outcome after CRT.
authors.affiliation: Cardiac Arrhythmia Service, Corrigan Minehan Institute Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Bose
authors.forename: Gaurav A
authors.initials: GA
authors.lastname: Upadhyay
authors.forename: Jagdesh
authors.initials: J
authors.lastname: Kandala
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Heist
authors.forename: Theofanie
authors.initials: T
authors.lastname: Mela
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Parks
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000401:mortality / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: cardiac resynchronization therapy; cardiac valve surgery; coronary artery bypass surgery; heart failure; heart transplant