Does Prior Valve Surgery Change Outcome in Patients Treated with Cardiac Resynchronization Therapy?
Dr. Upadhyay reports receiving salary support from the Max Schaldach Fellowship Award of the Heart Rhythm Society. Dr. Heist reports receiving honoraria from Biotronik, Boston Scientific, Sorin, and St. Jude Medical; research grants from Biotronik, Sorin, and St. Jude Medical; and consulting fees from Boston Scientific, Sorin, and St. Jude Medical. Dr. Mela reports receiving honoraria from Medtronic Inc., Biotronik, and St. Jude Medical. Dr. Parks reports receiving consulting fees from Thoratec Inc. and honoraria from Biotronik and Sorin. Dr. Singh reports serving as an advisor or consultant for Biotronik, Boston Scientific, Medtronic, Sorin, St. Jude Medical, Respicardia, and CardioInsight; serving as a speaker or a member of a speakers bureau for Biotronik, Boston Scientific, Sorin, and St. Jude Medical; and receiving grants for clinical research from Biotronik, Boston Scientific, Medtronic, and St. Jude Medical. Other authors: No disclosures.
Impact of Prior Valve Surgery in CRT Patients
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.
Methods and 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.
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.