scholarly journals Interventional and Minimally Invasive Surgical Techniques Facilitating Cardiac Resynchronization Therapy

10.5772/50291 ◽  
2012 ◽  
Author(s):  
Bela Merkely ◽  
Levente Molnar ◽  
Attila Rok
Keyword(s):  
Minimally Invasive ◽  
Cardiac Resynchronization Therapy ◽  
Surgical Techniques ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Minimally Invasive Surgical

Minimally Invasive Surgical Cardiac Resynchronization Therapy: An Intermediate-Term Follow-Up Study

2007 ◽  
Vol 2 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Joel S. Corvera ◽  
John D. Puskas ◽  
Vinod H. Thourani ◽  
Robert A. Guyton ◽  
Omar M. Lattouf
Keyword(s):  
Ejection Fraction ◽  
Minimally Invasive ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Inotropic Support ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Minimally Invasive Surgical ◽  
Qrs Duration

Background Cardiac resynchronization therapy (CRT) improves symptoms, quality of life, and ejection fraction in selected patients with congestive heart failure (CHF) and interventricular conduction delay. Transvenous insertion of left ventricular (LV) pacing leads via the coronary sinus is unsuccessful in 8–10% of patients. This study describes intermediate-term follow up of minimally invasive surgical techniques for CRT as a viable alternative after failed transvenous lead insertion. Methods From March 2001 to October 2005, fifty-four patients with NYHA Class III–IV symptoms, QRS duration 181 ± 40 milliseconds, and LV ejection fraction 19.7 ± 8.0% underwent a total of 56 minimally invasive LV lead placements via thoracoscopic video assistance (n = 38) or minithoracotomy (n = 17). One patient required full thoracotomy after a previous video-assisted thoracoscopic procedure. Intraoperative transesophageal echocardiography was used to assess changes in LV function. Results Acute thresholds for the active lead measured 1.10 ± 0.62 V, with R-wave amplitude of 12.3 ± 6.6 mV and impedance of 631 ± 185 Ohm. Thirty-day mortality was 5%. There were no perioperative myocardial infarctions or strokes. Five patients required transfusion, 3 had exacerbation of prior renal insufficiency, 5 had pulmonary complications, and 8 required inotropic support for more than 48 hours. Intermediate-term follow up (mean 20 ± 16 months, range 11 days to 55 months) revealed 3 patients with lead failure requiring additional surgical intervention. Hospitalization due to worsening CHF occurred in 5 patients, and 2 of these patients required intravenous inotropic support. QRS duration decreased to 146 ± 36 milliseconds postoperatively (P < 0.001). Conclusion Minimally invasive surgical lead placement safely and effectively accomplishes cardiac resynchronization using either thoracoscopic or minithoracotomy techniques.

Minimally Invasive Video-Assisted Epicardial Lead Cardiac Resynchronization Therapy for the Dilated Cardiomyopathy Heart Failure Cases

2010 ◽  
Vol 5 (5) ◽  
pp. 345-348 ◽  
Author(s):  
Hai-Bo Zhang ◽  
Xu Meng ◽  
Jie Han ◽  
Yan Li ◽  
Ya-Ping Zeng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Minimally Invasive ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Video Assisted ◽  
Epicardial Lead ◽  
The Mean

Objective Cardiac resynchronization therapy (CRT) with biventricular pacing has demonstrated cardiac function improvement in treating congestive heart failure. Traditional CRT through coronary sinus lead method is difficult to perform. Minimally invasive video-assisted epicardial lead (Epi-lead) CRT for the dilated cardiomyopathy heart failure cases was explored. Methods From April 2007 to June 2009, a total of 12 patients (age, 63 ± 9 years) with depressed systolic left ventricular (LV) function (ejection fraction, <35%), left bundle branch block (mean QRS [Q wave, R wave, S wave], 158 ± 15 milliseconds), and congestive heart failure of New York Heart Association class III/IV were enrolled. The patients received minimally invasive video-assisted epicardial steroid-eluting LV lead implantation for the CRT. The right atrial and right ventricle leads were implanted, guided by x-ray. The mean follow-up time was 13.7 months (range, 7–27 months). Results All patients received LV lead implantation at the most late-activated site. The mean QRS duration decreased significantly from 158 ± 15 to 124 ± 11 milliseconds (P < 0.05). There was no surgical or hospital mortality in the entire series. The mean procedure duration (skin to skin) of the LV lead implantation was 52.4 ± 15.8 minutes. The mean postoperative stay was 7.1 ± 2.7 days. During the follow-up, cardiac function improved significantly in 11 patients. Threshold capture of the Epi-leads remained stable at 1.12 ± 0.3 V/0.5 ms during the follow-up. None died during the follow-up. Conclusions Surgical Epi-lead placement for the resynchronization therapy is a safe and reliable technique and should be considered as an equal alternative.

Minimally invasive thoracoscopic technique for cardiac resynchronization therapy

2015 ◽  
Vol 2015 (0) ◽  
pp. mmv008-mmv008 ◽  
Author(s):  
A. Droghetti ◽  
M. C. Bottoli ◽  
M. Ragusa ◽  
P. Pepi ◽  
M. Giovanardi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Thoracoscopic Technique
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