title: Long-term cerebral thromboembolic complications of transapical endocardial resynchronization therapy.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is an established therapeutic option in selected heart failure patients (pts). However, the transvenous left ventricular (LV) lead implantation remains ineffectual in a considerable number of pts. Transapical LV (TALV) lead implantation is an alternative minimally invasive, surgical, endocardial implantation technique. The aim of the present prospective study is to determine the long-term outcome, including the cerebral thromboembolic complications, of pts who underwent TALV lead placement.
  
  
  METHODS
  Twenty-six CRT candidates (19 men (78 %); mean age 61 ± 10 years) with a previously failed transvenous approach underwent TALV lead placement as a last resort therapy. The following data was collected: mortality rate, reoperation rate, and cerebrovascular event rate. Patients underwent a cerebral CT scan to determine any possible cerebrovascular event related to the presence of the TALV lead.
  
  
  RESULTS
  Eleven out of 26 (47 %) patients survived after a median follow-up of 40 ± 24.5 months. Major acute ischemic stroke occurred in two cases, while in one case transient ischemic stroke was observed. Cerebral CT scan examination performed in asymptomatic patients revealed chronic ischemic lesions with minimal extension in two patients. Reoperation occurred in one case due to TALV lead fracture.
  
  
  CONCLUSIONS
  This is the first study reporting the long-term outcome, mortality, and thromboembolic event rate exclusively after TALV lead implantation. Patients who underwent TALV lead implantation have a comparable long-term mortality rate to conventional CRT, although a major ischemic cerebrovascular event after TALV lead implantation is worrisome and has an impact on the outcome.
authors.affiliation: Gottsegen György National Institute of Cardiology, Haller utca 29, 1094, Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Kis
authors.affiliation: United St Istvan and St Laszlo Hospital, Nagyvarad ter 1., 1097, Budapest, Hungary.
authors.forename: Andrea
authors.initials: A
authors.lastname: Arany
authors.affiliation: United St Istvan and St Laszlo Hospital, Nagyvarad ter 1., 1097, Budapest, Hungary.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gyori
authors.affiliation: Gottsegen György National Institute of Cardiology, Haller utca 29, 1094, Budapest, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Mihalcz
authors.affiliation: Gottsegen György National Institute of Cardiology, Haller utca 29, 1094, Budapest, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Kardos
authors.affiliation: Gottsegen György National Institute of Cardiology, Haller utca 29, 1094, Budapest, Hungary.
authors.forename: Csaba
authors.initials: C
authors.lastname: Foldesi
authors.affiliation: Gottsegen György National Institute of Cardiology, Haller utca 29, 1094, Budapest, Hungary.
authors.forename: Imre
authors.initials: I
authors.lastname: Kassai
authors.affiliation: Thoraxcenter, Department of Clinical Electrophysiology, Erasmus MC, 's Gravendijkwal 230, Kamer BD416, Postbus 2040, 3000 CA, Rotterdam, The Netherlands. t.szilitorok@erasmusmc.nl.
authors.forename: Tamas
authors.initials: T
authors.lastname: Szili-Torok
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D020766:Intracranial Embolism / Q000175:diagnosis / Q000401:mortality*; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: End-stage heart failure; Resynchronization therapy; Thromboembolic complication; Transapical left ventricle pacing