Video-assisted thoracoscopic left cardiac sympathetic denervation: a reliable minimally invasive approach for congenital long-QT syndrome.

BACKGROUND

The purpose of this study was to assess the feasibility and long-term effect of video-assisted thoracoscopic left cardiac sympathetic denervation for congenital long-QT syndrome.

METHODS

From December 2002 to May 2007, 11 patients who could not tolerate or who were refractory to beta-blocker therapy received video-assisted thoracoscopic left cardiac sympathetic denervation. Under general anesthesia, the pleural cavity was entered through three 1.5-cm incisions in the left subaxillary area. The left thoracic sympathetic chain was identified, and the lower one third of the left stellate ganglion, together with T(2) to T(5) sympathetic chain, was resected.

RESULTS

The mean operative time was 40.9 +/- 7.7 minutes. Blood loss was minimal. The mean postoperative stay was 6 +/- 1.4 days. There were no major perioperative complications apart from mild ptosis of the left upper eyelid in 1 patient who subsequently recovered shortly after the procedure. The mean follow-up time was 37.0 +/- 26.3 months. Seven of the patients are totally free of cardiac events and report good quality of life. One patient experienced decreased syncopal events from 5 or 6 times per year to 2 or 3 times per year. One patient still experiences syncopal events 3 to 4 times a year, but with shortened duration to several seconds. One patient reports syncope 10 times per year. Only 1 patient died, early in the second year after surgery. In conclusion, the overall efficacy rate (that is, reduction in syncopal episodes) is 81.8% (9 of 11) and the mortality rate, 9.1% (1 of 11).

CONCLUSIONS

Video-assisted thoracoscopic left cardiac sympathetic denervation is a simple and minimally invasive technique that results in good long-term benefits in patients with congenital long-QT syndromes.