PMID- 19800818
OWN - NLM
STAT- MEDLINE
DCOM- 20100511
LR  - 20100203
IS  - 1532-8422 (Electronic)
IS  - 1053-0770 (Linking)
VI  - 24
IP  - 1
DP  - 2010 Feb
TI  - Outcome after implantation of cardiac resynchronization/defibrillation systems in 
      patients with congestive heart failure and left bundle-branch block.
PG  - 30-6
LID - 10.1053/j.jvca.2009.07.009 [doi]
AB  - OBJECTIVE: The implantation of cardiac resynchronization/defibrillation devices 
      (CRT-Ds) increasingly is used in patients with congestive heart failure and left 
      bundle-branch block. There are no data on the effects of anesthesia and surgery 
      on outcome after implantation. DESIGN: A retrospective, observational study; 
      postoperative survey. SETTING: University hospital. PARTICIPANTS: Three hundred 
      forty-one patients (258 men/83 women, 63 +/- 9 years) with congestive heart 
      failure and left bundle-branch block who underwent CRT-D implantation in 1996 to 
      2005. MEASUREMENTS AND MAIN RESULTS: Perioperative data were retrieved from the 
      patients' records. Cardiologists caring for the patients were contacted to obtain 
      information on current New York Heart Association (NYHA) status and mortality 
      after CRT-D implantation. Preoperatively, 45 patients were classified as NYHA II, 
      246 as NYHA III, and 50 as NYHA IV. CRT was performed via thoracotomy in 100 and 
      transvenously in 241 cases. General anesthesia (propofol or sevoflurane and 
      remifentanil) was performed in 273 and local anesthesia (lidocaine) in 68 
      patients. Hypotension occurred mainly during general anesthesia (43% v 4%). The 
      30-day mortality was 0%. The postoperative survey started in 2006 and was 
      completed by 215 patients. The mean survival time was 77 months; 151 patients 
      survived the study period. Outcome was not influenced by local and general 
      anesthesia. Presence of preoperative NYHA class >II (odds ratio [OR] = 1.6, 
      confidence interval [CI] = 0.5-5.1), mitral regurgitation (OR = 2.5, CI = 
      1.2-5.5), and serum creatinine >1.1 mg/dL (OR = 3.0, CI = 1.5-6.2) resulted in an 
      inferior prognosis. CONCLUSIONS: In patients with severely impaired cardiac 
      function, general anesthesia for the implantation of a biventricular pacing 
      device can be used with justifiable risk. The method of anesthesia did not 
      influence outcome.
CI  - Copyright 2010 Elsevier Inc. All rights reserved.
FAU - Pfau, Giselher
AU  - Pfau G
AD  - Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke 
      University, D-39120 Magdeburg, Germany.
FAU - Schilling, Thomas
AU  - Schilling T
FAU - Kozian, Alf
AU  - Kozian A
FAU - Lux, Anke
AU  - Lux A
FAU - Gotte, A
AU  - Gotte A
FAU - Huth, Christof
AU  - Huth C
FAU - Hachenberg, Thomas
AU  - Hachenberg T
LA  - eng
PT  - Journal Article
DEP - 20091002
PL  - United States
TA  - J Cardiothorac Vasc Anesth
JT  - Journal of cardiothoracic and vascular anesthesia
JID - 9110208
SB  - IM
MH  - Aged
MH  - Anesthesia, General/*methods
MH  - Bundle-Branch Block/*therapy
MH  - Cardiac Pacing, Artificial/*methods
MH  - *Defibrillators, Implantable
MH  - *Electric Countershock/instrumentation/methods
MH  - Female
MH  - Heart Failure/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Postoperative Care
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Treatment Outcome
EDAT- 2009/10/06 06:00
MHDA- 2010/05/12 06:00
CRDT- 2009/10/06 06:00
PHST- 2009/02/27 00:00 [received]
PHST- 2009/10/06 06:00 [entrez]
PHST- 2009/10/06 06:00 [pubmed]
PHST- 2010/05/12 06:00 [medline]
AID - S1053-0770(09)00287-0 [pii]
AID - 10.1053/j.jvca.2009.07.009 [doi]
PST - ppublish
SO  - J Cardiothorac Vasc Anesth. 2010 Feb;24(1):30-6. doi: 10.1053/j.jvca.2009.07.009. 
      Epub 2009 Oct 2.