Loddo Paolo, Sionis Carla, Schintu Barbara, Paliogiannis Panagiotis
Heart Department, Unit of Thoracic and Vascular Surgery, Brotzu Hospital, Cagliari, Italy.
Heart Department, Unit of Cardiology, Brotzu Hospital, Cagliari, Italy.
Multimed Man Cardiothorac Surg. 2015 Jan 5;2015:mmu028. doi: 10.1093/mmcts/mmu028. Print 2015.
Cardiac resynchronization therapy is indicated in advanced heart failure patients with a wide QRS complex, because it restores the synchronicity of the atrioventricular, interventricular and intraventricular contractions. It is performed through endovascular implantation of one or more leads. Left cardiac lead positioning is one of the most challenging procedures in interventional cardiology; unfortunately, in up to 40% of cases no clinical improvements occur. Surgical implantation of a left ventricular lead is indicated in cases of failure or predicted unfeasibility of a transvenous positioning. Several surgical techniques have been described for implantation of left ventricular lead. Minimally invasive approaches, including video-assisted thoracic and robotic surgery, are favoured due to reduced trauma, pain and recovery time. Robotic surgery confers significant advantages for visualization and manoeuverability, which are important in patients with a history of cardiac surgery, in whom scarring and adhesions may render placement challenging. We describe here the surgical technique for robotic implantation of left ventricular leads in candidates for cardiac resynchronization therapy.
心脏再同步治疗适用于QRS波群增宽的晚期心力衰竭患者，因为它能恢复房室、室间和心室内收缩的同步性。该治疗通过血管内植入一根或多根导线来进行。左心导线定位是介入心脏病学中最具挑战性的操作之一；不幸的是，高达40%的病例未出现临床改善。在经静脉定位失败或预计不可行的情况下，需进行左心室导线的外科植入。已经描述了几种用于植入左心室导线的外科技术。由于创伤、疼痛和恢复时间减少，包括电视辅助胸腔镜手术和机器人手术在内的微创方法更受青睐。机器人手术在可视化和可操作性方面具有显著优势，这对于有心脏手术史的患者很重要，因为这些患者的瘢痕形成和粘连可能使导线放置具有挑战性。我们在此描述了在心脏再同步治疗候选患者中机器人植入左心室导线的手术技术。
