Minimal touch surgical implantable cardioverter defibrillator implantations

A growing number of patients with contraindication for transvenous implantable cardioverter defibrillator (ICD) implantation or need for system upgrade of a pre-existent pacemaker system is to be observed. Therefore, unconventional system constellation may be necessary to provide patient safety by using a minimal invasive access avoiding sternotomy. Two similar cases are presented to demonstrate configuration solutions which can be easily individually modified. Simple pacemaker and ICD implantation is nowadays mostly performed by cardiologists and/or general surgeons. As soon as partial or total thoracotomy becomes necessary, the patient will be referred to a department of cardiac surgery. Hence, in the very near future, cardiac surgeons will face a large number of redo procedures for pacemaker- and ICD systems including the necessity for mixed transvenous and epicardial solutions. To avoid significant morbidity deriving from sternotomy and pericardiotomy, concepts for as less invasive as possible solutions are presented.