Epicardial Cardioverter-Defibrillator Implantation Concomitant with Coronary Artery Bypass in Patients with Low Ejection Fraction

Abstract

Patients with severe left ventricular failure are directed to surgical revascularization owing to possibilities of improved survival and the associated postoperative functional status. However, when a postoperative ejection fraction > 35% is unlikely, patients are still at increased risk for sudden cardiac death due to malignant arrhythmias. We documented our results in patients with an ejection fraction < 35% who were concomitantly implanted with a cardioverter-defibrillator by surgical revascularization. We believe that simultaneous surgery is advantageous in terms of preventing sudden cardiac death in the early postoperative period and that it lacks necessity for further intervention.

Keywords

• Heart failure,coronary artery bypass,defibrillators,implantable,death,sudden,cardiac

Düşük Ejeksiyon Fraksiyonlu Hastalarda Koroner Baypas Cerrahisi ile Eş zamanlı Epikardiyal Kardiyoverter-Defibrilatör İmplantasyonu

Abstract

Ciddi sol ventrikül disfonksiyonu olan hastalar postoperatif artmış yaşam süresi ve düzelmiş fonksiyonel durum sebebiyle cerrahi revaskülarizasyona yönlendirilmektedir. Ancak, eğer postoperatif ejeksiyon fraksyonu > %35 olacak gibi değilse, hastalar halen malign aritmiler sebebiyle ani kardiyak ölüm için risk altındadır. Biz burada ejeksiyon fraksiyonu < %35 olan, cerrahi revaskülarizasyon ile eş zamanlı kardiyoverter-defibrilatör implantasyonu yapılan hasta sonuçlarımızı dökümante ettik. Biz bu hastalarda erken postoperatif dönemde ani kardiyak ölümün önlenmesi ve ikinci girişime ihtiyaç olmaması sebebiyle simültane cerrahinin avantajlı olduğunu düşünüyoruz.

Keywords

• Kalp yetmezliği,koroner arter baypas,implante edilebilir defibrilatör,ani kardiyak ölüm

References

1. 1. Pieri M, Belletti A, Monaco F, Pisano A, Musu M, Dalessandro V, et al. Outcome of cardiac surgery in patients with low preoperative ejection fraction. BMC Anesthesiology 2016;16:97.
2. 2. Shahian DM, O’Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: Part1-coronary artery bypass grafting surgery. Ann Thorac Surg 2009;88:S2-22.
3. 3. Salehi M, Bakhshandeh A, Rahmanian M, Saberi K, Kahrom M, Sobhanian K. Coronary artery bypass grafting in patients with advanced left ventricular dysfunction: excellent early outcome with improved ejection fraction. J Teh Univ Heart Ctr 2016;11:6-10.
4. 4. Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, et al. HRS/ACC/AHA expert consensus statement on the use of implantable cardioverter-defibrillator therapy in patients who are not included or not well represented in clinical trials. J Am Coll Cardiol 2014;64:1143-77.
5. 5. Peretto G, Durante A, Limite LR, Cianflone D. Postoperative arrhythmias after cardiac surgery: incidence, risk factors and therapeutic management. Cardiol Res Pract 2014;2014:615987.
6. 6. Edem E, Gürsoy MO, Pabuccu MT, Taş S, Can Y, Tekin Üİ, et al. Latent clinical outcomes of appropriate and inappropriate ICD shocks. Koşuyolu Heart Journal 2014;17:167-71.