Long-term outcomes, mortality predictors, and cardiac-device-related infective endocarditis in patients with surgically corrected valvular versus non-valvular heart failure treated with cardiac resynchronization therapy

Abstract

Background: Little is known about the prognosis in patients with valvular etiology of heart failure (HF) after cardiac surgery treated with cardiac resynchronization therapy (CRT). Aims: We aimed to assess long-term outcomes, mortality predictors, and the risk of cardiac device-related infective endocarditis (CDRIE) in patients with valvular etiology of HF after cardiac surgery treated with CRT. Methods: The study population involved 1059 consecutive patients with CRT implanted between 2002 and 2019 in a tertiary care university hospital in Poland. Results: The studied population was assigned to two groups: 1) the valvular group (n = 74; 7.0%) with HF patients after cardiac surgery treated with CRT, and 2) the non-valvular group (control group, n = 985; 93.0%) that included all other CRT recipients. During the median follow-up of 1661 days (815–2792), all-cause mortality of CRT recipients with valvular versus non-valvular HF did not differ significantly (50% vs. 54.4%; P= 0.46). Also, the risk of CDRIE was not different (2.7% vs. 5.7%; P= 0.28). In multivariable regression analysis, only older age (HR, 1.04; 95% CI, 1.01–1.07; P= 0.02) was identified as an independent predictor of higher mortality in patients with valvular HF treated with CRT. Conclusions: CRT recipients with valvular HF that had been corrected surgically have similar long-term mortality to CRT patients with non-valvular HF etiologies. In both, death rates reach 50% within 4.5 years. The risk of CDRIE is not higher in the valvular versus non-valvular group of CRT recipients, and advanced age appeared to be the only independent mortality predictor in patients with CRT implanted for valvular HF.