AI Article Synopsis
- The study analyzes the outcomes of patients with congestive heart failure and left bundle-branch block who underwent CRT-D implantation between 1996 and 2005, focusing on the effects of anesthesia on post-surgery results.
- Preoperative classifications showed varying degrees of heart failure among the 341 participants, and both general and local anesthesia were used; hypotension was more common with general anesthesia.
- Results indicated no significant difference in survival based on the type of anesthesia used, although certain preoperative factors like NYHA class and renal function were linked to poorer outcomes.
Article Abstract
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.
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| http://dx.doi.org/10.1053/j.jvca.2009.07.009 | DOI Listing |
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