title: Surgical placement of left ventricular lead for cardiac resynchronisation therapy after failure of percutaneous attempt.
abstract: OBJECTIVE
  Cardiac resynchronisation therapy has been shown to be an effective treatment to improve functional status and prolong survival of patients in advanced chronic heart failure. This study assessed the surgical outcomes of left anterior mini-thoracotomy for the implantation of left ventricular epicardial pacing leads in cardiac resynchronisation therapy.
  
  
  METHODS
  Our study consisted of 30 consecutive patients who underwent cardiac resynchronisation therapy with a left thoracotomy between November 2010 and April 2012 in our clinic. Postoperative follow up included the assessment of New York Heart Association (NYHA) functional class, electrocardiography and echocardiography.
  
  
  RESULTS
  There were 22 male and eight female patients with a mean age of 68 ± 5.04 years. All patients were in NYHA class III or IV. Pre-procedure mean left ventricular ejection fraction was 28.1 ± 4.5% and post-procedural ejection fraction improved to 31.7 ± 5.1%. The pre-operative QRS duration changed from 171.7 ± 10.8 to 156.2 ± 4.4 ms after the operation. Also there was a significant reduction in left ventricular end-diastolic dimension from 6.98 ± 0.8 to 6.72 ± 0.8 mm (p < 0 .05), but no change in left ventricular end-systolic dimension and severity of mitral regurgitation. All patients had successful surgical left ventricular lead placement. There was no procedure-related mortality. The mean follow-up time was 40.4 months.
  
  
  CONCLUSIONS
  Surgical epicardial left ventricular lead placement procedure is a safe and effective technique in patients with a failed percutaneous attempt.
authors.affiliation: Department of Cardiovascular Surgery, Bilim University, Istanbul, Turkey. Email: mehmet_ezelsoy@hotmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ezelsoy
authors.affiliation: Department of Cardiovascular Surgery, Mehmet Akif Ersoy Hospital, Istanbul, Turkey.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Bayram
authors.affiliation: Department of Cardiovascular Surgery, Bilim University, Istanbul, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Yazici
authors.affiliation: Cardiology, Florence Nightingale Hospital, Istanbul, Turkey.
authors.forename: Nuran
authors.initials: N
authors.lastname: Yazicioglu
authors.affiliation: Department of Cardiovascular Surgery, Bilim University, Istanbul, Turkey.
authors.forename: Ertan
authors.initials: E
authors.lastname: Sagbas
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium; D012189:Retrospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*