Cardiac resynchronization therapy markedly reduces the need for heart transplantation

The Journal of Heart and Lung Transplantation Volume 21, Number 1 the C group to 36.5% in the G group (p⬍0.01) during POD3-6, and further increase from 9.1% to 45.8% over POD7-10 (p⬍0.01). Again, proportional increases are seen in CD4⫹ and CD8⫹ cells. Although Bcl-2 expression between the C and G groups does not differ, Bax expression is increased 16.6-fold (50.8% vs 3.1%, p⬍0.01) in CD3⫹ cells during POD3-6. Additionally, Fas expression is increased 23.4-fold (68.2% vs 2.8%, p⬍0.01) in CD3⫹ cells over this same period. Elevated CD3⫹ cell Bax expression in the G group only occurs during POD3-6, whereas Fas expression continues to be elevated relative to the C group on POD7-10 (25.8% vs 3.6%, p⫽0.05). These results indicate IL-10 gene transfer enhances intragraft apoptosis of alloreactive T cells through enhanced Fas and Bax expression, and this T cell depletion prolongs graft survival. 194 5 YEAR RESULTS AFTER PARTIAL LEFT VENTRICULECTOMY IN AN EUROPEAN HEART FAILURE POPULATION W. Konertz,1 H. Hotz,1 D. Kivelitz,2 M. Zytowski,1 1 Cardiovascular Surgery, Charite´ Berlin, Berlin, Germany; 2 Radiologie, Charite´ Berlin, Berlin, Germany Background: One hundred consecutive patients undergoing partial left ventriculectomy (Batista) surgery between January 1995 and December 2000 were studied. Methods: Patient ages ranged from 12 to 85 years, and all patients were in NYHA functional class III or IV. 44 patients had ischemic, 45 idiopathic, and 11 valvular myopathy. Inclusion criteria were left ventricular end diastolic volume index more then 150 ml/ m2, left ventricular ejection fraction of less 20%, or left ventricular end-diastolic diameter more then 70 mm. 38 patients were transplant candidates. Partial left ventriculectomy and mitral valve repair by means of a annuloplasty ring plus the Alfieri repair were only part of complex cardiac reconstruction in 54 patients. Results: 15 patients died early and 19 late between 2 and 30 months postoperatively. Actuarial 1, 2, 3, 4 and 5 year survival is at 70, 60, 58, 58, 58% respectively. Left ventricular (LV) diameter could be reduced from a preoperative mean of 73 to 55 mm postoperatively. LV ejection fraction increased to 36% in ischemic and to 25% in idiopathic patients. Computed electron beam tomography within 3 months and more then 1 year after surgery showed no repeat dilatation. 68% of the patients received an ICD before discharge. Postoperatively 80% of patients are in NYHA functional class I or II. Conclusions: Patients with end-stage idiopathic or ischemic cardiomyopathy can be improved considerably with partial left ventriculectomy. Any cardiac comorbidity should be repaired simultaneously. 195 CARDIAC RESYNCHRONIZATION THERAPY MARKEDLY REDUCES THE NEED FOR HEART TRANSPLANTATION J.M. Greenberg, A.R. Leon, D.B. DeLurgio, J.J. Langberg, B.J. Hott, W.M. Book, A.L. Smith, Department of Cardiology, Emory University, Atlanta, GA Background: Cardiac transplantation is considered therapy for patients with congestive heart failure (CHF) who are on optimal medical therapy with NYHA class III or IV symptoms, an ejection fraction (EF) ⱕ30%, and a maximum oxygen uptake

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(VO2) ⱕ14mL x kg (-1) x min (-1). Cardiac resynchronization therapy (CRT) has now become an FDA approved therapy to treat patients with severe CHF and QRS durations greater than 130ms. The benefits of CRT in cardiac transplant candidates are currently unclear. Methods: The subjects for this study were all enrolled at our center in trials of CRT. (Miracle, InSync ICD, Companion, or Contak CD) To determine the effects of CRT on transplant candidates, we reviewed those patients (n⫽34) whose age was ⱕ67 and met all of the following criteria: a QRS duration ⬎130ms, NYHA class III or IV symptoms, EF ⱕ30%, and a maximum VO2 ⱕ14mL x kg (-1) x min (-1). The ventricular function, oxygen uptake, and NYHA class was compared at baseline and after six months of active therapy for each patient. Results: CRT reduced the QRS duration from 178⫾29 to 143⫾17ms (p⬍.0001) and the NYHA class from 3. 1⫾0.3 to 1.8⫾0.7 (p⬍.0001). The EF increased from 18.4⫾5.1 to 25.1⫾8.4% (p⬍.0001) and the maximum VO2 increased from 11.9⫾1.8 to 15.3⫾3mL x kg (-1) x min (-1) (p⬍.0001). Twentythree of thirty-four patients had a maximumVO2 ⱖ14mL x kg (-1) x min (-1) at six months. Only two of the initial thirty-four patients still met the criteria for transplantation at 6 months. All of the patients were alive at a mean follow-up of 15 months. Conclusion: CRT improves ventricular function, oxygen uptake, and NYHA class in patients who might be considered candidates for cardiac transplantation and have a QRS ⬎ 130ms. Transplantation can be prevented or deferred in a majority of patients. Outpatients with chronic CHF and a widened QRS should be evaluated for CRT prior to listing for cardiac transplantation.

196 RESYNCHRONIZATION THERAPY IN PATIENTS WITH LBBB AND END STAGE HEART FAILURE: REAL ALTERNATIVE OR BRIDGING TO CARDIAC TRANSPLANTATION ? G. Tenderich, B. Schulze, B. Hansky, K. Minami, R. Koerfer, Thoracic and Cardiovascular Surgery, Heart Center NRW, University Bochum, Bad Oeynhausen, Germany Introduction: Biventricular pacing in pts with LBBB was reported to improve functional and hemodynamic parameters and considered as optional therapy to cardiac transplantation. The influence of the prognosis in terms of survival and necessity of transplantation is not well established.