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The Annals of Thoracic Surgery, Vol 58, 1609-1613, Copyright © 1994 by The Society of Thoracic Surgeons

ARTICLES

One-incision approach for insertion of implantable cardioverter defibrillators

A Markewitz, H Kaulbach, S Mattke, U Dorwarth, C Weinhold, E Hoffmann, G Steinbeck and B Reichart
Department of Cardiac Surgery, University of Munich, Grosshadern Hospital, Germany.

The placement of a transvenous implantable cardioverter defibrillator (ICD) system through a single infraclavicular skin incision has been a surgical goal for years. The development of a new investigational model of ICD with substantially reduced dimensions (volume, 83 cm3; mass, 132 g) has made the one-incision approach a clinical reality. Between March and September 1993, 4 female and 19 male patients (mean age, 60 +/- 9.6 years; range, 46 to 73 years) underwent implantation of this device for the treatment of ventricular fibrillation (n = 14) or ventricular tachycardia (n = 9). One transvenous lead was placed in the right ventricular apex and another in the left subclavian vein. A subpectoral pocket was formed in the infraclavicular area from the same incision to house the ICD generator and, if necessary, the subcutaneous patch. The mean operation time (81.5 +/- 32.7 minutes; range, 54 to 195 minutes) was significantly shorter than that noted for a previous series made up of patients undergoing traditional transvenous ICD implantations. In 20 patients (87%), endovenous defibrillation without a subcutaneous patch successfully caused externally induced ventricular fibrillation to revert with a mean minimum energy output of 21.9 +/- 3.5 J (range, 12 to 24 J). Endovenous defibrillation was more successful when biphasic (n = 16/17 [94%]) shocks rather than monophasic shocks (n = 4/6 [67%]) were used. No mortality, morbidity, or surgical complications were observed. These results indicate that the one-incision approach and the small size of the ICD generator can substantially facilitate ICD implantation and result in a reduction in the surgical trauma, the operation time, and the amount of material implanted.

This article has been cited by other articles:

				W. R. Wilson, G. E. Greer, and B. P. Grubb Implantable Cardioverter-Defibrillators in Children: A Single-Institutional Experience Ann. Thorac. Surg., March 1, 1998; 65(3): 775 - 778. [Abstract] [Full Text] [PDF]

				K J Lipscomb, N J Linker, and A P Fitzpatrick Subpectoral implantation of a cardioverter defibrillator under local anaesthesia Heart, March 1, 1998; 79(3): 253 - 255. [Abstract] [Full Text]