Left Video Assisted Thoracoscopic Sympathectomy For Life Threatening Arrhythmias - 10 Years' Experience.
Manoras M. Chengalath, Jr., Krish Chaudhuri, Parma Nand, David Haydock.
Greenlane Clinic, Auckland City Hospital, Auckland, New Zealand.
Background: The sympathetic nervous system has an important role in the production of ventricular tachyarrythmias. Sympathectomy with denervation of left lower fibres of stellate ganglion up to T4 level has shown long lasting benefits and is an important consideration in treatment for these patients. Methods: We retrospectively analysed 62 patients who underwent left video assisted thoracoscopic (VATS) sympathectomy at our institution from September 2008 to October 2018. One approach involved a 3-port axillary access technique while the other approach employed a single port in the axilla. All patients underwent intubation to allow for left lung isolation. The sympathetic fibres from lower third of stellate ganglion to T4 level was cauterized. At the end of all procedures, air was evacuated and no intraoperative intercostal drains were inserted. Patient demographics, indication for sympathectomy, procedural technique, operating times, length of hospital stay, need for postoperative chest drain, electrocardiographic outcomes and complications were noted. Results: Of the 62 patients, 53 had long QT syndrome, 8 had Catecholaminergic polymorphic ventricular tachycardia and one patient had drug induced long QT. The mean age was 22 years. The indications in most of them were syncopal episodes which led to the diagnosis. Many patients had family members with long QT syndrome. The mean procedural time was 23 minutes. 2 patients required chest drain postoperatively for pneumothorax. Patients were discharged home in a mean of 2.0 days. Shortening of QT interval was seen in approximately 62% of patients. The requirement for implantable defibrillators (ICD) later was roughly 28%. Compensatory hyperhidrosis was seen in 9% and partial Horner's syndrome in 8%. Only two patients had mild left ptosis persisting for longer than 6 months. Conclusions: VATS Sympathectomy is a simple uncomplicated promising adjunctive therapy in patients with symptoms and could reduce the load of sudden death due to life threatening arrhythmias. This operation is to be considered in all patients who fail optimal medical management and who have frequent discharges of their defibrillator devices. Many patients could do away with ICD for a longer time with this procedure.
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