Division of Cardiothoracic Services, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom.
Ann Thorac Surg. 2013 Mar;95(3):907-13. doi: 10.1016/j.athoracsur.2012.11.022. Epub 2013 Jan 11.
Left ventricular epicardial lead placement via video-assisted thoracoscopy (VAT) is a recognized surgical technique to achieve cardiac resynchronization therapy (CRT) when conventional lead placement has failed. Its role in patients with previous sternotomy is uncertain. We describe our experience in a cohort of patients including those with previous sternotomy.
This was a retrospective review of consecutive patients undergoing VAT lead implantation for CRT in a single center between 2004 and 2011. All patients fulfilled conventional criteria for CRT and were followed up at 4 to 6 weeks and then at 3-month intervals. Clinical and pacing parameters were compared at baseline and at the latest review.
Thirty-two patients (27 men; mean age, 67 ± 9 years) underwent VAT left ventricular lead implantation. Mean follow-up duration was 704 ± 450 days. Ten patients (31%) had undergone previous sternotomy. Thoracoscopic lead implantation was successful in 31 patients (97%): 1 patient with two previous sternotomies required conversion to open thoracotomy due to bleeding with multiple adhesions. Satisfactory implantation pacing thresholds of 2 volts or less at 0.5 ms were achieved in all patients. Despite a longer operative time in those with previous sternotomy, all clinical and pacing outcomes, including complications, clinical response to CRT, and long-term pacing variables were similar between the groups.
VAT left ventricular lead placement appears safe and effective in selected patients with previous sternotomy, including coronary artery bypass operations, with postoperative outcomes comparable with those patients without previous sternotomy.
经视频辅助胸腔镜（VAT）行左心室心外膜导线放置术是一种公认的手术技术，可在常规导线放置失败时实现心脏再同步治疗（CRT）。其在既往行胸骨切开术患者中的作用尚不确定。我们描述了我们在一组包括既往行胸骨切开术患者在内的患者中的经验。
这是对 2004 年至 2011 年期间在单一中心接受 VAT 导线植入以进行 CRT 的连续患者进行的回顾性研究。所有患者均符合 CRT 的常规标准，并在术后 4 至 6 周和 3 个月间隔进行随访。在基线和最近一次随访时比较临床和起搏参数。
32 例患者（27 例男性；平均年龄 67 ± 9 岁）接受了 VAT 左心室导线植入术。平均随访时间为 704 ± 450 天。10 例患者（31%）既往行胸骨切开术。31 例患者（97%）成功进行了胸腔镜导线植入术：2 例既往行两次胸骨切开术的患者因出血伴多处粘连而需要转为开胸手术。所有患者均实现了满意的植入起搏阈值，即 2 伏或更低，0.5 毫秒。尽管既往有胸骨切开术的患者手术时间较长，但两组之间的所有临床和起搏结果，包括并发症、CRT 临床反应和长期起搏变量均相似。
VAT 左心室导线放置术在既往行胸骨切开术的患者中似乎是安全有效的，包括冠状动脉旁路手术，术后结局与无既往胸骨切开术的患者相似。
