Outcome of video-assisted thoracoscopic implantation of epicardial left ventricular leads with visual targeting for cardiac resynchronization therapy.

Stauber, Annina; Tanner, Hildegard; Noti, Fabian; Roten, Laurent; Seiler, Jens; Lam, Anna; Medeiros-Domingo, Argelia; Servatius, Helge; Tran, Van Nam; Carrel, Thierry; Weber, Alberto (2020). Outcome of video-assisted thoracoscopic implantation of epicardial left ventricular leads with visual targeting for cardiac resynchronization therapy. Interactive cardiovascular and thoracic surgery, 30(3), pp. 373-379. Oxford University Press 10.1093/icvts/ivz276

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OBJECTIVES Our goal was to analyse the implantation and outcome of thoracoscopic epicardial leads after a failed endovascular approach or follow-up (FU) complications after endovascular implantation. METHODS We reviewed the records of patients with failed endovascular left ventricular (LV) lead placement or complications during FU, who were subsequently referred to cardiac surgeons for treatment with thoracoscopic LV lead implantation. We analysed the reasons for endovascular failure; the indications for the surgical procedures; and the clinical, echocardiographic and device FU results. RESULTS Between 2010 and 2013, a total of 23 patients were included. Among them, 17 of the patients had no previous cardiothoracic surgery, 13 (76%) had successful video-assisted thoracoscopy (VAT) LV lead implantation, 3 (18%) had a conversion to thoracotomy and 1 (6%) failed. Of the 6 patients with prior cardiothoracic surgery, 2 (33%) had VAT only, 3 (50%) had primary thoracotomies and 1 (17%) had a conversion. Two major complications occurred. The reasons for LV endovascular lead failure were subclavian vein occlusion (n = 2), implant failure (n = 13) and complications during the FU period (n = 8). FU information was available for 20 patients: 17 (85%) had improved symptoms. The median FU period was 33 months. A total of 78% of patients were in New York Heart Association (NYHA) functional class III-IV before the operation; 30% were in NYHA functional class III-IV at the last FU examination. The left ventricular ejection fraction increased from 25% before surgery to 31% at the last FU examination. Overall, sensing and pacing threshold values remained stable over time. In 1 patient, lead revision was necessary due to an increase in the pacing threshold. CONCLUSIONS VAT implantation of LV leads had an excellent response rate with an improvement in NYHA functional class and left ventricular ejection fraction. The lead measurements were mainly stable over time.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Tanner, Hildegard; Noti, Fabian; Roten, Laurent; Seiler, Jens; Lam, Anna; Medeiros Domingo, Argelia; Servatius, Helge Simon and Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1569-9293

Publisher:

Oxford University Press

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

27 Dec 2019 12:47

Last Modified:

28 Feb 2020 01:32

Publisher DOI:

10.1093/icvts/ivz276

PubMed ID:

31800041

Uncontrolled Keywords:

Cardiac resynchronization therapy Epicardial lead Heart failure Left ventricular lead Thoracoscopic Video-assisted thoracoscopic

BORIS DOI:

10.7892/boris.136680

URI:

https://boris.unibe.ch/id/eprint/136680

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