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Video-Assisted Thoracoscopic Left Ventricular Pacing in Patients With and Without Previous Sternotomy

Lookup NU author(s): Dr Andrew Turley, Dr Nicholas Linker, Dr Andrew OwensORCiD

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Abstract

Background: Left ventricular epicardial lead placement via video-assisted thoracoscopy (VAT) is a recognized surgical technique to achieve cardiac resynchronization therapy (CRT) when conventional lead placement has failed. Its role in patients with previous sternotomy is uncertain. We describe our experience in a cohort of patients including those with previous sternotomy. Methods: This was a retrospective review of consecutive patients undergoing VAT lead implantation for CRT in a single center between 2004 and 2011. All patients fulfilled conventional criteria for CRT and were followed up at 4 to 6 weeks and then at 3-month intervals. Clinical and pacing parameters were compared at baseline and at the latest review. Results: Thirty-two patients (27 men; mean age, 67 ± 9 years) underwent VAT left ventricular lead implantation. Mean follow-up duration was 704 ± 450 days. Ten patients (31%) had undergone previous sternotomy. Thoracoscopic lead implantation was successful in 31 patients (97%): 1 patient with two previous sternotomies required conversion to open thoracotomy due to bleeding with multiple adhesions. Satisfactory implantation pacing thresholds of 2 volts or less at 0.5 ms were achieved in all patients. Despite a longer operative time in those with previous sternotomy, all clinical and pacing outcomes, including complications, clinical response to CRT, and long-term pacing variables were similar between the groups. Conclusions: VAT left ventricular lead placement appears safe and effective in selected patients with previous sternotomy, including coronary artery bypass operations, with postoperative outcomes comparable with those patients without previous sternotomy.

Publication metadata

Author(s): Nelson KE, Bates MA, Turley AJ, Linker NJ, Owens WA

Publication type: Article

Publication status: Published

Journal: Annals of Thoracic Surgery

Year: 2013

Volume: 95

Issue: 3

Pages: 907-913

Print publication date: 11/01/2013

ISSN (print): 0003-4975

ISSN (electronic): 1552-6259

Publisher: Elsevier Inc.

URL: http://dx.doi.org/10.1016/j.athoracsur.2012.11.022

DOI: 10.1016/j.athoracsur.2012.11.022

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