Robotic-Assisted Left Ventricular Epicardial Lead Placement in Patients With Prior Sternotomy

Area of Science:

• Cardiology
• Minimally Invasive Surgery
• Medical Device Technology

Background:

• Cardiac resynchronization therapy (CRT) enhances function in heart failure patients with left ventricular (LV) dysfunction.
• Traditional intravenous lead placement may be unsuitable for some patients, necessitating surgical epicardial LV lead placement.
• Prior sternotomy presents challenges for epicardial lead placement, often favoring thoracotomy over thoracoscopy due to adhesions.

Purpose of the Study:

• To evaluate the feasibility and outcomes of robotic-assisted LV lead placement in patients with a history of sternotomy.
• To explore a less invasive surgical approach for CRT lead implantation in a challenging patient population.

Main Methods:

• A retrospective review of consecutive patients with prior sternotomy undergoing robotic-assisted epicardial LV lead placement.
• Data collected from January 2018 to July 2023 at a single institution.

Main Results:

• Successful lead placement was achieved in all 6 analyzed patients (mean age 75 years) using the robotic approach.
• The median length of stay was 2 days, with 0% 30-day mortality.
• One patient required conversion to thoracotomy; complications included one phrenic nerve injury and one wound infection requiring device explant.

Conclusions:

• Robotic-assisted LV lead placement is a viable and safe option for patients with prior sternotomy requiring CRT.
• The approach demonstrates acceptable perioperative outcomes and lengths of stay, even in patients with significant comorbidities.
• This technique may expand CRT eligibility for patients with contraindications to conventional epicardial lead implantation.