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Bilateral Thoracoscopic Sympathectomy After Sternotomy for Left Ventricular Assist Device Insertion
Audrey L Khoury1, Kristin Weiss2, Benjamin E Haithcock1
1Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
The Annals of Thoracic Surgery
|January 27, 2022
Summary
This case study details a simultaneous left ventricular assist device implantation and bilateral sympathectomy for refractory ventricular tachycardia. Thoracoscopic assistance improved visualization during the sympathectomy procedure.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Devices
Background:
- Persistent ventricular tachycardia (VT) poses a significant therapeutic challenge, often refractory to standard treatments like ablation and stellate ganglion blocks.
- Patients with refractory VT may experience recurrent syncope, frequent hospitalizations, and advanced heart failure, necessitating complex interventions.
Observation:
- A 73-year-old male patient presented with recurrent syncope due to persistent VT, alongside acute on chronic congestive heart failure requiring an intraaortic balloon pump.
- Previous treatments including VT ablation and multiple stellate ganglion blocks had failed to resolve the symptoms.
Findings:
- A simultaneous procedure involving left ventricular assist device (LVAD) implantation and bilateral sympathectomies was performed.
- The sympathectomy involved removing the lower stellate ganglia to the T4 level, with thoracoscopic assistance enhancing visualization during the sternotomy.
Implications:
- This combined approach offers a potential strategy for managing complex, refractory ventricular tachycardia and associated heart failure.
- The integration of thoracoscopy in sympathectomy during LVAD placement may improve surgical outcomes and safety.
