Minimally Invasive Thoracoscopic Technique for LV Lead Implantation in CRT Patients
| Autor: | Sergio Valsecchi, Stefano Branzoli, Roberto Bonmassari, Monica Campari, Paolo Moggio, Massimiliano Marini, Maria Caterina Bottoli, Andrea Droghetti, Giuseppina Belotti, A. Graffigna, Giulio Molon, C. Pederzolli, Fabrizio Guarracini, Alessio Coser, Silvia Quintarelli, Claudio Pomarolli, Maurizio Centonze |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Phrenic nerve stimulation business.industry medicine.medical_treatment Cardiac resynchronization therapy 030204 cardiovascular system & hematology medicine.disease Surgery 03 medical and health sciences 0302 clinical medicine Ventricular fibrillation medicine Intubation Transvenous approach 030212 general & internal medicine Cardiology and Cardiovascular Medicine Lead (electronics) business Concomitant conditions Procedure time |
| Zdroj: | Journal of Clinical & Experimental Cardiology. |
| ISSN: | 2155-9880 |
| DOI: | 10.4172/2155-9880.1000575 |
| Popis: | Background: Epicardial placement of the left ventricular (LV) lead is an alternative approach to the standard cardiac resynchronization therapy (CRT) procedure. In our center we developed a minimally invasive thoracoscopic technique. We reviewed our experience to evaluate the long-term safety and effectiveness of the technique. Methods: The procedure is performed under general anesthesia with oro-tracheal intubation and right-sided ventilation, and requires 3 thoracoscopic ports (two 5-mm and one 15-mm). We analyzed 94 consecutive patients referred to our center for epicardial LV lead implantation. Results: Five patients were excluded because of concomitant conditions precluding surgery or lack of indication for CRT. The remaining 89 patients underwent the procedure. Of these, 57 had undergone previous unsuccessful LV lead implantation (Group 1). In the remaining 32 patients, effective CRT was discontinued owing to LV lead dislodgment (Group 2). LV lead implantation was successful in all patients (median pacing threshold 0.8V, IQR: 0.6-1.2, at 0.5 ms, no phrenic nerve stimulation) and CRT was successfully established in all but one patient. No complications were reported, except for 2 cases of transitory peri-electrode bleeding and 3 cases of ventricular fibrillation induced during the procedure (no sequelae). The median procedure time was 75 min (IQR: 55-95). During a median follow-up of 24 [IQR: 13-39] months, 21 patients died and 4 additional device-related complications were reported (comparable rates between groups). Conclusions: Our thoracoscopic approach proved to be safe and effective. It is a viable alternative to the standard transvenous approach in the case of failed de novo implantation and in those patients who positively respond to CRT but experience LV lead dislodgment. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|