Minimally Invasive Epicardial Pacemaker Lead Implantation And Pacemaker Extraction
Fatih Gumus, Ali Ihsan Hasde, Cagdas Baran, Alper Ozgur, Mustafa Bahadir Inan, Mustafa Serkan Durdu, Levent Yazicioglu, Ahmet Ruchan Akar, Kemalettin Ucanok.
Ankara University, ankara, Turkey.
Background:Left ventricular pacemaker lead dislocations and lead endocarditis are commonly seen in high volume centers. Following use of minimally invasive techniques in cardiac surgery pacemaker lead implantation and extraction via thoracotomy incisions became the preferred technique in many centers. Our aim was to evaluate the results of the patients undergoing minimally invasive pacemaker lead implantation or extraction in our center. Methods:Between June 2014 and December 2018, 23 consecutive patients were underwent epicardial pacemaker lead implantation through video-assisted (VA) minimally invasive left lateral throcatomy due to the complete atrioventricular block for whom a transvenous approach was failed and 9 patients underwent VA minimally invasive pacemaker extraction due to lead endocarditis (n=6) or no need of existing pacemaker (n=3) through right lateral thoractomy and right atriotomy under cardiopulmonary bypass. All patients were evaluated by a CT scan to rule out any thoracopulmonary disease before surgery. Results:The mean age was 59.2 ± 16.4 years and 16 (50.0%) were male. The EF was 23.2 ± 6.1, 10 (66.6%) were in NYHA functional classes III/IV. Thirty-one minimal invasive LV lead implantations were performed, one electrode was re-dislocated after the procedure. All of the lead implantations were performed via a left thoracotomy off pump. Left ventricle later walla was the preferred implantation site. Following implantation the LV pacing threshold was 1.21 ± 0.3 V/0.5 ms. Procedural time was 31 ± 14.2 min, while the mean hospital stay was 3.4± 1.8 days. All pacing parameters remained stable over time at a mean follow-up of 415 days. Lead extractions were performed through VA right lateral throcatomy on beating heart. Tricuspid annular repair was required in three patients. No complications were seen postoperatively. Conclusion: The application of the minimally invasive surgery in the implantation or extraction of the pacemaker electrodes was safe and feasible. Moreover, the utilization of 3D camera mode will offer an easy and precise manipulation as much as the surgeons have in sternotomy.
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