Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
Heart Lung Circ. 2019 Jul;28(7):1121-1126. doi: 10.1016/j.hlc.2018.06.1041. Epub 2018 Jun 22.
The placement of a temporary epicardial pacing wire is a challenge during a minimally invasive redo cardiac operation. The aim of this study is to assess the application of temporary endocardial pacing in patients who underwent minimally invasive redo tricuspid surgery.
Perioperative data of consecutive patients who underwent thoracoscopic redo tricuspid surgery were collected. All the tricuspid surgeries and combined procedures were performed under peripheral cardiopulmonary bypass without aortic cross-clamping. A sheath was introduced into the right jugular vein beside the percutaneous superior vena cava cannula and a temporary endocardial pacing catheter was guided into the right ventricle via the sheath prior to the right atrial closure. The pacemaker was connected and run as needed during or after operation.
A total of 33 patients who underwent thoracoscopic redo tricuspid surgery were enrolled. Symptomatic tricuspid valve regurgitation (93.9%) and tricuspid valvular prosthesis obstruction (6.1%) after previous cardiac operations were noted as indications for a redo surgery. The mean time from previous cardiac operation to this time redo surgery was 13.3±6.4years. Isolated tricuspid valve replacement was performed in 18 patients (54.5%) and tricuspid valve plasty combined with or without mitral valve replacement was performed in 15 patients (45.5%). A temporary endocardial pacing catheter was successfully placed in the right ventricle for all patients with good sensing and pacing. No temporary pacing related complications occurred from insertion to removal of pacing catheter in the patients.
This application of temporary endocardial pacing provided a safe and effective substitute for epicardial pacing in patients who underwent minimally invasive redo tricuspid surgery.
在微创心脏再次手术中，临时心外膜起搏线的放置是一项挑战。本研究旨在评估临时心内膜起搏在微创三尖瓣再次手术患者中的应用。
收集连续接受胸腔镜微创三尖瓣再次手术的患者的围手术期数据。所有三尖瓣手术和联合手术均在体外循环下进行，不夹闭主动脉。在经皮上腔静脉插管旁的右颈静脉插入鞘管，并通过鞘管将临时心内膜起搏导管引导至右心室，然后关闭右心房。必要时在术中或术后连接起搏器并运行。
共纳入 33 例接受胸腔镜微创三尖瓣再次手术的患者。先前心脏手术后出现症状性三尖瓣反流（93.9%）和三尖瓣瓣架阻塞（6.1%）是再次手术的指征。上次心脏手术后到此次再次手术的平均时间为 13.3±6.4 年。18 例（54.5%）患者行单纯三尖瓣置换术，15 例（45.5%）患者行三尖瓣成形术联合或不联合二尖瓣置换术。所有患者均成功将临时心内膜起搏导管放置在右心室，具有良好的感知和起搏功能。在患者中，从起搏导管插入到取出，没有发生与临时起搏相关的并发症。
在微创三尖瓣再次手术中，临时心内膜起搏的应用为心外膜起搏提供了一种安全有效的替代方法。
