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Ann Thorac Surg 1992;53:978-983
© 1992 The Society of Thoracic Surgeons

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Articles

Implantation of cardioverter defibrillators in the post-sternotomy patient

Divisions of Cardiothoracic Surgery and Cardiology, Medical College of Virginia, Richmond, Virginia USA

^_* Address reprint requests to Dr Damiano, Division of Cardiothoracic Surgery, Medical College of Virginia, MCV Station, Box 645, Richmond, VA 23298 USA.

In an attempt to minimize the hazards of redo stemotomy or thoracotomy in patients who have undergone previous cardiac procedures, a technique has been developed for cardioverter dcfibrillator implantation that involves dissection through a left subcostal incision and placement of extrapericardial defibrillation patches. This approach was used in 22 consecutive patients who required an implantable cardioverter defibrillator 4 to 156 months after previous median sternotomy. Defibrillation threshold energy was less than or equal to 20 J in every patient. Ninety-one percent of patients were extubated during the first 24 hours and were transferred out of the intensive care unit by the second postoperative day. One patient died of an acute myocardial infarction 3 days postoperatively ([equation], 4.5%). It was necessary to replace one lead for mechanical failure of an adapter, one patch required repositioning, and 1 patient needed drainage of a persistent pleural effusion ([equation], 13.6%). No further complications occurred during 3 to 27 months of followup. Advantages of the subcostal approach included prompt extubation, a single incision, and minimal morbidity. This approach is safe and effective, and is the method of choice for implantation of a cardioverter defibrillator in patients who have undergone prior sternotomy.

This article has been cited by other articles:

				J. S. Lawton, K. A. Ellenbogen, M. A. Wood, B. S. Stambler, J. A. Spratt, A. S. Wechsler, and R. J. Damiano Jr Clinical experience with nonthoracotomy cardioverter defibrillators Ann. Thorac. Surg., May 1, 1995; 59(5): 1092 - 1099. [Abstract] [PDF]

				C. A. S. Marrin, C. C. Canver, M. Greenberg, P. Holzberger, S. K. Plume, and W. C. Nugent Subxiphoid approach for insertion of ICDs after previous median sternotomy Ann. Thorac. Surg., August 1, 1993; 56(2): 312 - 315. [Abstract] [PDF]