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Related Experiment Videos

Lateral thoracotomy for the automatic implantable defibrillator.

A D Slater1, I Singer, C Stavens

  • 1Department of Surgery, University of Louisville, KY 40292.

Archives of Surgery (Chicago, Ill. : 1960)
|June 1, 1991
PubMed
Summary

A muscle-sparing lateral thoracotomy is effective for implantable cardioverter-defibrillator (ICD) lead placement. This approach offers excellent exposure, allows lead repositioning, and prevents complications, especially in patients with prior cardiac procedures.

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Area of Science:

  • Cardiology
  • Thoracic Surgery

Background:

  • Automatic implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias.
  • Traditional lead implantation methods can be invasive and carry risks.

Purpose of the Study:

  • To evaluate the efficacy and safety of a muscle-sparing lateral thoracotomy approach for ICD lead implantation.
  • To assess the benefits of this technique in patients with previous intrapericardial procedures.

Main Methods:

  • A lateral thoracotomy approach with complete muscle sparing was used for ICD lead implantation in 51 patients.
  • Lead repositioning for optimal defibrillation thresholds was performed when necessary.
  • Intrapericardial dissection was utilized in patients with prior intrapericardial procedures.

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Main Results:

  • Excellent exposure was achieved, facilitating lead repositioning in 18 patients.
  • Five of 19 patients with prior intrapericardial procedures required intrapericardial dissection for satisfactory defibrillation thresholds.
  • No intraoperative deaths or infarctions occurred; 30-day mortality was 3.9%.

Conclusions:

  • A muscle-sparing lateral thoracotomy is a favorable approach for ICD insertion.
  • This technique is particularly beneficial for patients with a history of previous intrapericardial procedures.
  • Muscle-sparing techniques and epidural anesthesia reduced pulmonary complications and the need for prolonged ventilation.