Title of article :
Minimally Invasive Left Ventricular Epicardial Lead Placement: Surgical Techniques for Heart Failure Resynchronization Therapy
Author/Authors :
Jose L. Navia، نويسنده , , Fernando A. Atik، نويسنده , , Richard A. Grimm and ACUTE Investigators، نويسنده , , Mario Garcia-Sanz، نويسنده , , Pablo Ruda Vega، نويسنده , , Ulf Myhre، نويسنده , , Randall C. Starling، نويسنده , , Bruce L. Wilkoff، نويسنده , , David Martin، نويسنده , , Penny L. Houghtaling، نويسنده , , Eugene H. Blackstone، نويسنده , , Delos M. Cosgrove III، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2005
Pages :
9
From page :
1536
To page :
1544
Abstract :
Background Epicardial lead placement for biventricular pacing is often a rescue procedure after failed coronary sinus cannulation. This study aims to determine perioperative and early postoperative outcome of minimally invasive left ventricular lead placement as a management strategy for heart failure, comparing minithoracotomy and endoscopic approaches. Methods From October 2002 through October 2003, 41 patients underwent minimally invasive left ventricular lead placement, 23 (56%) by minithoracotomy and 18 (44%) endoscopically. Thirty-one (76%) were males, 19 (46%) had previous cardiac surgery, 21 (51%) had ischemic cardiomyopathy, 17 (41%) were in New York Heart Association class III or IV, and 28 (65%) had implantable cardioverter-defibrillators. Results There were no in-hospital deaths, intraoperative complications, or failures to implant the left ventricular lead. Median operative time was longer for the endoscopic approach (188 minutes) than for minithoracotomy (151 minutes; p = 0.006). Preoperatively, the endoscopic group had more mitral regurgitation (median, 2.5 versus 1.0, respectively; p = 0.009). QRS duration was shorter postoperatively (mean change from preoperative, −32 ± 24 ms; p< 0.0001); this change was unrelated to surgical approach. Impedance also was less postoperatively (mean change, −490 ± 300 ohms; p< 0.0001), and the change was unrelated to surgical approach. Changes were greater the larger their preoperative values (p< 0.0001). Threshold increased with follow-up time (adjusted p< 0.0001), but impedance decreased (adjusted p = 0.0009); these trends were similar for both approaches. No changes were evident in left ventricular dimensions. Conclusions Minimally invasive left ventricular epicardial lead placement is safe and effective, offering selection of the best pacing site with minimal morbidity; it can be considered a primary option for resynchronization therapy.
Journal title :
The Annals of Thoracic Surgery
Serial Year :
2005
Journal title :
The Annals of Thoracic Surgery
Record number :
608571
Link To Document :
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