Cardiac resynchronization therapy in graft failure

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Abstract

Although coronary artery bypass graft (CABG) surgery has had major advances in surgical techniques and will minimize patients’ clinical symptoms and improve survival, vein grafts continue to have high failure rates. If graft failure occurs, it will lead to worsening outcomes such as recurrent myocardial infarction (MI) and heart failure (HF). It has been shown that in select HF patients, cardiac resynchronization therapy (CRT) would lead left ventricular reverse remodeling and improve patients’ symptoms, quality of life, exercise tolerance, and fi nally improve survival. Most heart failures in patients following CABG are due to graft failures, which are related to occurring ischemia burden or scar tissue due to myocardial infarction. Therefore, in select patients, CRT may also have a benefi cial effect, such as in non-CABG heart failure patients. Wider QRS complex with left bundle branch block morphology, low ejection fraction and New York Heart Association (NYHA) functional class II or higher are the only criteria for patient selection as recommended by many guidelines. If the ischemia burden is signifi cant, then its management should be discussed with the local Heart Team (including intervention cardiologist and cardiac surgeon) whether additional percutaneous coronary intervention (PCI) or redo CABG should be performed despite CRT or CRT defi brillator (CRT-D) implantation. The complications related with CRT implantation are left ventricle (LV) lead dislodgement, phrenic nerve stimulation (PNS), and coronary sinus dissection. Although the complication rate is quite low, the implanter should take into consideration these potential complications. New techniques and devices for CRT implantation are now widely used and new advanced LV lead technology is commencing; hence the implantation technique will become easier and safer. The proper follow-up, especially for atrio-ventricular (AV) and ventriculo-ventricular (VV) optimization, is also important and needed besides successful CRT or CRT-D implantation.

Original languageEnglish
Title of host publicationCoronary Graft Failure
Subtitle of host publicationState of the Art
PublisherSpringer International Publishing
Pages623-635
Number of pages13
ISBN (Electronic)9783319265155
ISBN (Print)9783319265131
DOIs
Publication statusPublished - 1 Jan 2016

Keywords

  • Cardiac resynchronization therapy
  • Coronary artery bypass graft
  • Graft failure
  • Heart failure

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