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Objectives: To evaluate the long-term performance of the SonRtip atrial lead. Background: To optimize atrioventricular and interventricular timing and thereby potentially improving cardiac resynchronization therapy (CRT) responder rates, a lead integrated technology and a cardioverter/defibrillator-based algorithm measuring peak endocardial acceleration have been introduced. Long-term performance of the atrial lead (SonRtip PS55D, Sorin/MicroPort CRM, Italy) embedded with such a sensor has not been reported so far. Methods: Between 2012 and 2018, 143 patients underwent implantation of the SonRtip atrial lead in four Austrian medical centers. Conventional bipolar atrial leads implanted during the same period in 526 patients receiving CRT were used as control cohort. Results: Among 669 patients included in the study, 10 (1.5%) showed increased atrial pacing thresholds and/or decreased atrial sensing amplitudes and/or sudden increase in atrial lead impedance (above 3000 Ω) after an uneventful early postoperative period. Seven (70%) of the malfunctioning leads were SonRtip leads (p <0.001). Lead replacement was needed in 4.2% of SonRtip leads (six out of 143) and in 0.38% of all other conventional atrial leads (two out of 526) (p <0.001). Because of unaltered atrial sensing properties, a wait and see strategy was chosen in two patients–one of them with a SonRtip lead. The implanted atrial lead in the latter person experienced a sudden increase in pacing threshold (4V/0.35ms). Conclusions: While short-term safety and stable technical performance of the SonRtip atrial lead could be confirmed, our study found an unexpectedly high malfunction rate over a longer follow-up period. [ABSTRACT FROM AUTHOR]

Objectives: Increasing experience with minimally invasive cardiac (MIC) aortic valve (AV) replacement makes AV reoperations (rAVR) an appealing alternative to conventional redo surgery. The aim of the study was to compare the perioperative outcome after isolated MIC versus full-sternotomy (FS) rAVR., Methods: We retrospectively analyzed data of 116 patients from three centers who underwent rAVR by using a FS ( n  = 70, 60.3%) or a partial upper sternotomy approach ( n  = 46, 39.7%). Both groups were compared in terms of 30-day mortality by using binary-logistic regression models. Further the EuroSCORE II was used to adjust for preoperative conditions in a multivariable model. Perioperative times and complications were compared between the two groups., Results: There was no statistically significant difference in perioperative mortality between FS ( n  = 5, 7.1%) and MIC ( n  = 1, 2.2%) rAVR in the original population (odds ratio [OR] 3.462, 95% confidence interval [CI] 0.391-30,635, p  = 0.264) and after adjusting for EuroSCORE II (OR 2.759, 95% CI 0.298-25.567, p  = 0.372). Cardiopulmonary bypass- (115.5 minutes vs. 137.5 minutes, p  = 0.070) and cross-clamp times (69.0 minutes vs. 81.0 minutes, p  = 0.028) were reduced in the MIC group. There was a lower prevalence of postoperative renal failure requiring renal replacement therapy (RRT) in the MIC group 0 and 8.6% ( p  = 0.041), respectively. No differences were detected between the groups regarding postoperative complications., Conclusion: MIC rAVR is associated with reduced cardiopulmonary and cross-clamp times as well as the need for RRT as compared with FS. MIC-rAVR seems to be a viable option in surgical candidates for AV reoperations., Competing Interests: None., (Georg Thieme Verlag KG Stuttgart · New York.)