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José L. Navia
Fernando A. Atik
Pablo Ruda Vega
Ulf Myhre
Randall C. Starling
David Martin
Eugene H. Blackstone
Delos M. Cosgrove
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Right arrow Electrophysiology - arrhythmias

Ann Thorac Surg 2005;79:1536-1544
© 2005 The Society of Thoracic Surgeons


Original articles: Cardiovascular

Minimally Invasive Left Ventricular Epicardial Lead Placement: Surgical Techniques for Heart Failure Resynchronization Therapy

José L. Navia, MDa,*, Fernando A. Atik, MDa, Richard A. Grimm, MDb, Mario Garcia, MDb, Pablo Ruda Vega, MDa, Ulf Myhre, MDa, Randall C. Starling, MDb, Bruce L. Wilkoff, MDb, David Martin, MD, MPHa,b, Penny L. Houghtaling, MSc, Eugene H. Blackstone, MDa,c, Delos M. Cosgrove, MDa

a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
b Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
c Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio

Accepted for publication October 26, 2004.

* Address reprint requests to Dr Navia, Dept of Thoracic and Cardiovascular Surgery/F24, 9500 Euclid Ave, Cleveland, OH 44195 (E-mail: naviaj{at}ccf.org).

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

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.




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