The external vein graft support with mesh tubing reduces intimal and medial layer thickening and cell proliferation in composite vein grafts transplanted in the arterial position.
Background: Systolic dyssynchrony is present in a considerable number of patients with heart failure (HF) undergoing coronary artery bypass grafting (CABG). Surgical revascularization offers an optimal setting for totally epicardial cardiac resynchronization therapy (CRT) system implantation. Aim: To assess the efficacy of totally epicardial CRT implantation during CABG, in patients with HF. Methods: Twenty three patients with HF and dyssynchrony underwent totally epicardial CRT system implantation during CABG. This randomised, single-blind, cross-over study compared clinical and echocardiographic parameters during two periods: 3 months of active CRT (CRT+) and 3 months of inactive CRT (CRT−) pacing. Results: Twenty two patients underwent randomisation and completed both study periods. In the CRT+ group more patients improved by two NYHA classes (p = 0.028), had a longer 6-minute walk test distance (p = 0.047) and better quality of life (p = 0.003) compared with the CRT− group. Echocardiography revealed an improved LV ejection fraction (p b 0.001), smaller LV end-systolic volume (p = 0.04), reduced mitral regurgitation (p = 0.026) and improved LV synchrony in the CRT+ group compared with the CRT− group. Conclusion: CRT delivered by a totally epicardial system implanted during CABG is associated with additional improvement of clinical and echocardiographic parameters in patients with HF and systolic dyssynchrony.
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