Costa Roberto, Silva Katia Regina da, Martinelli Filho Martino, Carrillo Roger
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Miller School of Medicine, University of Miami, Miami, USA.
Arq Bras Cardiol. 2017 Oct;109(4):331-339. doi: 10.5935/abc.20170126. Epub 2017 Sep 4.
Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB).
This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates.
Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position.
All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively.
Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.
很少有研究描述先天性完全性房室传导阻滞（CCAVB）新生儿行心外膜起搏器植入后的手术结果。
本研究旨在评估采用剑突下入路进行微创心外膜起搏器植入术治疗新生儿的长期疗效。
2002年7月至2015年2月，16例因CCAVB连续接受心外膜起搏器植入术的新生儿。其中12例（75.0%）患有与CCAVB相关的先天性心脏病。患者平均年龄为4.7±5.3天，9例（56.3%）为女性。所有患者均通过微创剑突下入路植入双极类固醇洗脱心外膜导线，并固定于膈面心室表面。脉冲发生器置于上腹部肌下位置。
所有手术均成功，无围手术期并发症或早期死亡。平均手术时间为90.2±16.8分钟。所有患者均未出现起搏或感知功能障碍，在4.1±3.9年的随访期内所有参数均保持稳定。3例儿童因电池正常耗尽分别于4.0、7.2和9.0岁时接受了脉冲发生器更换，无需更换心室导线。起搏器植入后12天和325天分别有2例死亡，原因分别是溶栓治疗引起的出血和进行性难治性心力衰竭。
CCAVB新生儿通过剑突下入路植入心外膜起搏器在技术上是可行的，且具有良好的手术效果和起搏导线寿命。
