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Comparison of three cardioverter defibrillator implantation techniques: initial results with transvenous pectoral
A Anvari1, G Stix, M Grabenwöger
1Department of Cardiology, University of Vienna, Austria.
Insights
Transvenous pectoral implantable cardioverter-defibrillator (ICD) placement offers significant advantages over epicardial and abdominal approaches. This method reduces complications, shortens procedure times, and lowers hospitalization costs for patients.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Procedures
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias.
- Different ICD implantation methods, including epicardial, transvenous abdominal, and transvenous pectoral, have varying clinical and economic outcomes.
Purpose of the Study:
- To compare the perioperative complications, procedure duration, hospital length of stay, and associated costs of epicardial, transvenous abdominal, and transvenous pectoral ICD implantation.
Main Methods:
- A retrospective analysis of 121 patients undergoing ICD implantation via three different surgical approaches.
- Data collected included perioperative complications (within 30 days), duration of surgery, hospital length of stay, and total hospitalization costs.
- Hospital costs were estimated using a fixed daily rate.
Main Results:
- Transvenous pectoral ICD implantation showed significantly fewer severe perioperative complications and no perioperative mortality compared to epicardial and transvenous abdominal methods.
- Procedure times were shortest for pectoral (58 min) and longest for epicardial abdominal (154 min) implants.
- Hospital length of stay and total costs were substantially lower for pectoral implants ($4,068) versus abdominal ($9,975) and epicardial ($14,887) approaches.
Conclusions:
- Transvenous pectoral ICD implantation is associated with superior outcomes regarding safety, efficiency, and cost-effectiveness compared to epicardial and transvenous abdominal methods.
- The findings support transvenous pectoral implantation as the preferred approach for ICD placement.
Abstract:
A total of 121 patients underwent epicardial (n = 32), transvenous abdominal (n = 30), and transvenous pectoral (n = 59) ICD implants. Perioperative complications were defined as those occurring within 30 days after surgery. Hospital costs were calculated with $750 per day as a fixed charge. Duration of surgery was the time between the first skin incision and the last skin suture. Severe perioperative complications that were life-threatening or required surgical intervention occurred in the epicardial (6%) and transvenous (10%) abdominal groups, but not in the pectoral group. Perioperative mortality occurred only in the epicardial abdominal group, predominantly in patients with concomitant surgery (18%), and in 5% of patients without concomitant surgery. The duration of surgery was significantly shorter for transvenous pectoral implantation (58 +/- 15 min, P < 0.05) compared to transvenous abdominal implantation (115 +/- 38 min). Epicardial abdominal ICD implantation had the longest procedure time (154 +/- 31 min). The postimplant hospital length of stay was significantly shorter for pectoral implantation (5 +/- 3 days, P < 0.05) compared to transvenous (13 +/- 5) and epicardial (19 +/- 5) abdominal implantation. Total hospitalization costs significantly decreased in the pectoral implantation group ($4,068 +/- $2,099 for the pectoral group vs $14,887 +/- $4,415 and $9,975 +/- $3,657 for the epicardial and the transvenous abdominal group, respectively, P < 0.05). These initial results demonstrate the advantage of transvenous pectoral ICD implantation in terms of perioperative complications, procedure time, hospital length of stay, and hospitalization costs.
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