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Ann Thorac Surg 1992;54:791-793
© 1992 The Society of Thoracic Surgeons

Articles

Bilateral anterior thoracotomy for automatic implantable cardioverter defibrillator placement in patients with previous sternotomy

Shreekanth V. Karwande, MD*, John R. Rowles, MD

Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Medical Center, Salt Lake City, Utah, USA

Accepted for publication June 15, 1992.

* Address reprint requests to Dr Karwande, Division of Cardiothoracic Surgery, University of Utah Medical Center, 50 North Medical Dr, Salt Lake City, UT 84132.

Bilateral anterior thoracotomy, extrapericardial patches, and endocardial sensing lead placement have been used in 40 patients with previous sternotomy. The mean defibrillation threshold was 15 J, and in all patients the defibrillation threshold was less than 20 J. The surgical procedure is simplified with less risk by avoiding dissection of previously operated regions. Serious pulmonary complications have been avoided by adequate pain control with epidural analgesia and early mobilization. This technique has successfully been used in patients with underlying chronic obstructive pulmonary disease and amiodarone-induced pulmonary fibrosis. All patients have been extubated by the first postoperative day.




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S. M. Habal, I. B. David, and R. M. Luceri
Simplified subxiphoid placement of implantable cardioverter defibrillators using a posterior rectus pocket
Ann. Thorac. Surg., March 1, 1994; 57(3): 723 - 725.
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