Long-term cerebral thromboembolic complications of transapical endocardial resynchronization therapy

Abstract

PurposeCardiac 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.MethodsTwenty-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.ResultsEleven 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.ConclusionsThis 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.

Systematic review and meta‐analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?

“…This contrasts with transapical implants which showed a trend for more strokes, although concerns exist regarding INR control in the Kis et al. cohort . Of note, concerns about MR, with leads that traverse the MV, were not borne out in the included studies …”

“…Quality assessment of the included studies is shown in the Supplementary Data. The full text studies met more data quality criteria with the largest study, ALSYNC, being rated the highest …”

“…Most studies utilized the interatrial septum to access the left side of the heart, with the interventricular septum used two in studies, with the subclavian vein used to access the septum and deliver the lead. Three studies used an LV apical approach, via a thoracotomy, to deliver the lead to the endocardium …”

“…Active leads were used in all but one of the studies that specified lead type. Lead material was either polyurethane, silicon, or a combination of the two …”

“…The full text studies met more data quality criteria with the largest study, ALSYNC, being rated the highest. 8,[13][14][15][16][17][18][19][20][21][22]…”