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Left thoracotomy for cardiac resynchronization therapy using the Electrode Myopore Suturless Myocardial Pacing.
Fabrizio Ceresa1, Fabrizio Sansone1, Giuseppe Calvagna2, Maria Paola Maiorana3, Giuseppe Busā4, Rosario Evola2, Francesco Patanč1.
1Division of Cardiac Surgery, Papardo-Piemonte Hospital, Messina, Italy, Messina, Italy, 2Division of Cardiology, San Vincenzo Hospital, Taormina, Italy, Taormina, Italy, 3Division of Anesthesiology, San Vincenzo Hospital, Taormina, Italy, Taormina, Italy, 4Division of Cardiology, Papardo-Piemonte Hospital, Messina, Italy, Messina, Italy.
OBJECTIVE:
Cardiac resynchronization therapy improves symptoms and survival in patient with advanced heart failure. Usually, a percutaneous trans-venous approach allows a safe lead implantation. In case of failure of the percutaneous approach or for an incidental displacement of the lead, surgical implantation is recommended: a left thoracotomy is a valuable approach.
METHODS:
Between Jannuary 2010 and September 2011, 15 patients (14 males, mean age 68.6±14.0 years) underwent surgical implantation of the Myopore Suturless Myocardial Pacing Lead that was screwed directly into the left ventricular wall. All patients have been previously implanted with both a right atrial and ventricular leads and suffered from advanced cardiac failure with a NYHA class III or IV, an ejection fraction of 27.4±5.7% and a QRS complex duration of 200.0±37.8 msec. Three patients had previous cardiac surgery and four patients suffered from infective endocarditis of the percutaneous lead, requiring removal. The implantation was performed through a small left thoracotomy (5 cm) to the 5th intercostal space under selective right lung ventilation.
RESULTS: We have no surgical complications or deaths. Bleeding was < 200 cc in all patients and no cases of pneumothorax are reported so far. All patients were awakened into the operating room and mechanical ventilation was usually interrupted within 30 minutes after procedure. The mean follow-up was 10.7± 8.3 months and we had no cases of late mortality or dislodgement or loss of capture of the lead. The use of myopore suturless lead ensured a fast implantation (38.5±3.0 min) and obtained a very low thresholds of stimulation, ranging from 1.3±0.2 V at 0,5 ms intra-operatively and 0.9±0.3 V at 0,5 ms before the hospital discharge. The QRS duration decreased up to 140.8±27.4 msec (p<0,05)
CONCLUSIONS:
In conclusion, left thoracotomy for cardiac resynchronization therapy is a safe approach when compared twith full sternotomy in a such high risk population. The Myopore Suturless Myocardial Pacing Lead ensures a very fast implantation, reducing the invasiveness of the procedure. The interesting threshold of stimulation may increase the device’s lifespan.
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