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Long-term cerebral thromboembolic complications of transapical endocardial resynchronization therapy
Zsuzsanna Kis1, Andrea Arany2, Gabriella Gyori2
1Gottsegen György National Institute of Cardiology, Haller utca 29, 1094, Budapest, Hungary.
Insights
Transapical left ventricular (TALV) lead placement for cardiac resynchronization therapy (CRT) shows a 47% survival rate at 40 months. While long-term mortality is comparable to conventional CRT, cerebrovascular events are a significant concern.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Procedures
Background:
- Cardiac resynchronization therapy (CRT) improves heart failure outcomes in select patients.
- Transvenous left ventricular (LV) lead implantation is not always successful.
- Transapical LV (TALV) lead placement offers a minimally invasive surgical alternative for LV lead implantation.
Purpose of the Study:
- To evaluate the long-term outcomes of transapical LV (TALV) lead placement.
- To assess cerebral thromboembolic complications following TALV lead implantation.
- To determine the mortality and reoperation rates in patients undergoing TALV lead placement.
Main Methods:
- Prospective study of 26 CRT candidates with prior failed transvenous lead attempts.
- TALV lead placement performed as a last resort therapy.
- Data collection included mortality, reoperation, and cerebrovascular event rates; cerebral CT scans were used to detect events.
Main Results:
- 47% survival rate (11/26) after a median follow-up of 40 months.
- Two major acute ischemic strokes and one transient ischemic stroke occurred.
- Two asymptomatic patients showed minimal chronic ischemic lesions on CT; one reoperation was needed for lead fracture.
Conclusions:
- This study is the first to report long-term outcomes specifically for TALV lead implantation.
- Long-term mortality after TALV lead implantation appears comparable to conventional CRT.
- Major ischemic cerebrovascular events post-TALV lead implantation are a significant concern impacting patient outcomes.
Purpose:
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.
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