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