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ÖKG-Jahrestagung – Abstracts

J KARDIOL 2008; 15 (5–6)

147

Conclusion In this sheep model with induced HF, endocardial

and epicardial pacing of the lateral myocardium led to optimal

systolic function and hemodynamics, right ventricular pacing in-

duced further reduction of LV performance. As this optimal pacing

site cannot always be reached via the coronary sinus, surgical im-

plantation of epicardial electrodes should be considered in all non-

responding patients.

Spherical Dilatation of the Apex in Failing left Ventri-

cles: A Target for Surgical Remodelling Techniques

071

O. Dzemali

, N. Monsefi

, A. Zierer

, F. Bakhtiary

, T. Vogl

, P. Kleine

, A. Moritz

Department of Thoracic and Cardiovascular Surgery;

Department of Radiology,

Johann Wolfgang Goethe University, Frankfurt/Main, Germany

Background The present study investigates the geometry of fail-

ing left ventricles especially focussing on the apical deformation.

A new surgical remodelling technique is presented.

Methods and Results The geometry of the left ventricle (LV)

was evaluated by MRI scanning in 124 heart failure patients under-

going CABG. Besides the conventional sphericity index SI 2 further

indices were calculated, a length index (LV lengthsyst/LV length-

diast) and an apical conicity index (apical axis/short axis). The

results were compared to 15 patients with normal LV function and

10 test persons. A new apical compression stitch was placed in

35 heart failure patients; a second MRI was performed to evaluate

the remodelling result.

In failing left ventricles LV length increased (enddiastolic diameter

5.3 ± 0.6 cm/m

vs 4.7 ± 0.8 cm/m

in control patients and 4.6 ±

0.3 cm/m

in test persons). The length index was also elevated (0.94

± 0.04 vs 0.78 ± 0.06 and 0.81 ± 0.07). The classical systolic

sphericity index was 0.56 ± 0.06 in heart failure patients vs 0.50 ±

0.05 in control patients and 0.48 ± 0.04 in test persons. The apical

conicity indices were 0.71 ± 0.08 vs 0.59 ± 0.07 and 0.58 ± 0.06,

thus the deformation was more pronounced at the apex. A signifi-

cant remodelling was achieved in the apical stitch patients.

The length index improved to 0.85 ± 0.1, the apical index to 0.62 ±

0.06.

Conclusions Detailed analysis of the geometry of failing left ven-

tricles demonstrated reduction in longitudinal contractility as well

as spherical deformation with pronounced apical dilatation. An api-

cal remodelling stitch led to significant remodelling which was ac-

companied by improvement in ventricular function.

Impact of Different Pacing Modes on Left

Ventricular Function Following Cardiopul-

monary Bypass 072

O. Dzemali

, F. Bakhtiary

, A. Zierer

, H. Ackermann

, P. Kleine

A. Moritz

Department of Thoracic and Cardiovascular Surgery;

Department

of Biomedical Statistics, University Hospital, Johann Wolfgang

Goethe University, Frankfurt/Main, Germany

Background Patients with severely impaired left

ventricular (LV) function often demonstrate pro-

longed inter- and intraventricular conduction. This

prospective study investigates hemodynamic effects

and outcomes of perioperative temporary biventricu-

lar pacing in patients with heart failure undergoing

heart surgery.

Methods Eighty consecutive cardiac surgery pa-

tients with a LV ejection fraction below 35 % received

biventricular stimulation via temporary myocardial

electrodes. Group 1 consisted of 40 patients with LV

dilatation (mean-LVEDD 65 ± 5 mm), group 2 of 40

patients with normal or slightly dilated LV (mean-

LVEDD 52 ± 4 mm).

Results Hemodynamic parameters were measured

immediately, 6 and 24 hours after operation. An in-

crease of cardiac index (CI) and arterial blood pressure with

biventricular pacing was observed in 27 patients (group 1/67.5 %)

versus 22 patients (group 2/55 %) from 2.4 ± 0.7 l/min/m

to 3.5 ±

0.5 l/min/m

(p < 0.01). This benefit persisted 6 and 24 hours

postoperatively. The remaining patients already showed higher car-

diac index prior to pacing (3.7 ± 0.9 l/min/m

). In group 1, respond-

ing patients required shorter times for ventilation support and inten-

sive care. QRS duration before surgery was not predictive for the

response to biventricular pacing.

Conclusions In the majority of patients with reduced LV func-

tion, temporary biventricular pacing improves CO and arterial

blood pressure after surgery, especially when LV-dilatation is

present.

Ergebnisse nach PTCA, Stent und CABG bei Patien-

ten nach Herztransplantation 091

T. Dziodzio, A. Juraszek, S. Roedler, M. Czerny, St. Mahr, D. Zimpfer, R. Gottardi,

D. Dunkler, M. Grimm, A. Zuckermann

Abteilung für Herz-Thoraxchirurgie, Medizinische Universität Wien

Ziel dieser Untersuchung war es, unsere Ergebnisse nach PTCA,

Stentimplantation und Koronarbypassoperation zur Behandlung

der Graftvaskulopathie nach Herztransplantation (HTX) zu evaluie-

ren.

Methode Im Zeitraum 1989 bis 2006 wurden 55 Patienten (11 %

weiblich) aufgrund einer symptomatischen Graftvaskulopathie be-

handelt. Das Durchschnittsalter zum Zeitpunkt der HTX war 49

Jahre. Der Zeitraum zwischen HTX und der Revaskularisation war

im Mittel 103 Monate. Es wurden insgesamt 298 Läsionen behan-

delt. Dreiundachtzig Läsionen sind primär dilatiert worden, 124

Läsionen sind primär oder sekundär mit einem Stent versorgt wor-

den und 5 Patienten wurden primär bypassoperiert.

Die primäre Erfolgsrate, die Restenoserate sowie sekundäre kardia-

le Spätkomplikationen wurden monitiert.

Ergebnis Die primäre Erfolgsrate betrug 99 %. Der durchschnitt-

liche Nachbeobachtungszeitraum nach der Revaskularisation war

72 Monate, währenddessen wurden 26 % Läsionen nach primärer

PTCA und 15 % Läsionen nach primärem oder sekundärem Stent

nachinterveniert. In der Gruppe der Patienten nach Bypassoperation

waren alle Bypässe bei der jeweiligen Kontrolle einwandfrei offen.

Zwei Patienten sind im Verlauf an einem Myokardinfarkt verstor-

ben und 2 Patienten sind aufgrund der fortschreitenden ischämi-

schen Kardiomyopathie retransplantiert worden. Weitere 2 Patien-

ten sind aus nicht-kardialer Ursache verstorben.

Table 1: O. Dzemali et al.

Baseline Lateral wall Inferior wall Apex RV

Endocardial

Heart rate

82.8 ± 10.2 102.0 ± 4.5 102.0 ± 4.5 99.8 ± 7.4 97.2 ± 1.9

RR mean

73.0 ± 17. 7 82.2 ± 13.2 65.0 ± 16.7 64.0 ± 18.4 58.8 ± 11.6

PAPmean

18.8 ± 6.9 19.6 ± 11.9 18.4 ± 5.1 18.8 ± 5.9 17.0 ± 5.4

PCWP

12.4 ± 5.5 10.8 ± 3.6 14.0 ± 3.5 14.8 ± 3.5 15.6 ± 4.1

2.7 ± 0.4 3.8 ± 0.65 2.8 ± 0.6 2.7 ± 1.1 2.0 ± 0.9

LVDd

4.87 ± 0.7 4.06 ± 0.8 5.25 ± 0.2 5.16 ± 0.6 5.91 ± 0.2

IVSd

1.40 ± 0.2 1.85 ± 0.1 0.99 ± 0.2 1.28 ± 0.2 0.64 ± 0.4

Epicardial

Heart rate

– 103.0 ± 6.7 102.0 ± 4.5 100.0 ± 0 96.2 ± 5.8

RR mean

– 83.0 ± 16.1 66.2 ± 15.8 67.6 ± 10.2 56.4 ± 12.4

PAPmean

– 18.4 ± 5.4 18.2 ± 3.9 19.6 ± 5.1 19.2 ± 4.3

PCWP

– 10.6 ± 3.4 15.6 ± 2.8 15.2 ± 3.2 14.8 ± 3.3

– 3.6 ± 0.65 2.7 ± 0.4 2.5 ± 0.7 2.1 ± 0.5

LVDd

– 4.55 ± 0.4 5.83 ± 0.6 5.6 ± 0.7 5.67 ± 0.4

IVSd

– 1.79 ± 0.2 0.99 ± 0.3 1.11 ± 0.1 0.67 ± 0.3

LVDd = diastolic LV diameter; IVSd = interventricular septum diameter

(p < 0.05);

(p > 0,05)

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