Damiani Diana, Agosta Viviana Teresa, D'Andria Ursoleo Jacopo, Bottussi Alice, Licheri Margherita, Muriana Piergiorgio, Monaco Fabrizio
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Int J Cardiol. 2025 Feb 15;421:132890. doi: 10.1016/j.ijcard.2024.132890. Epub 2024 Dec 11.
Bilateral cardiac sympathetic denervation (CSD) performed via video-assisted thoracoscopic (VAT) surgery shows potential in managing ventricular tachycardia (VT), thereby reducing arrhythmic burden. In this setting, the scarcity of studies addressing both perioperative and long-term outcomes creates a substantial gap in the optimal management of patients with multiple comorbidities and limited treatment options. This observational study aimed to assess the medical comorbidities, as well as the short- and long-term outcomes of patients who underwent CSD for VT refractory to catheter ablation and medical therapy at a referral tertiary teaching hospital.
We retrospectively analyzed data of all patients with VT who underwent bilateral CSD-VAT surgery at a single center. Unadjusted Kaplan-Meier survival curves were generated to analyze the survival rates at 1-year and 2-years following the procedure.
Ten consecutive patients were unrolled between August 2014 and March 2024. Bilateral CSD-VAT surgery was successfully performed in all patients. Pre-operative ejection fraction was 33 % (26-41). Two patients (22 %) suffered cardiogenic shock and 1 vasoplegia. Half (50 %) of the patients necessitated inotrope/vasopressor support and 1 an intra-aortic balloon pump. Median hospital stay was 12 (9-19) days. Three (33 %) patients required postoperative ICU admission. All patients were alive upon hospital discharge. Neither major surgical complications nor complications typically associated with VAT-CSD (e.g., Horner's syndrome) were observed. The 1-year survival was 80 % while the survival at 24 months was 60 %.
CSD-VAT is a feasible rescue treatment in patients with refractory VT and is associated with limited intra- and postoperative complications alongside an acceptable long-term survival rate.
通过电视辅助胸腔镜（VAT）手术进行双侧心脏交感神经去神经支配（CSD）在治疗室性心动过速（VT）方面显示出潜力，从而减轻心律失常负担。在这种情况下，针对围手术期和长期结局的研究稀缺，这在合并多种疾病且治疗选择有限的患者的最佳管理方面造成了巨大差距。本观察性研究旨在评估在一家转诊三级教学医院接受CSD治疗对导管消融和药物治疗无效的VT患者的医疗合并症以及短期和长期结局。
我们回顾性分析了在单一中心接受双侧CSD-VAT手术的所有VT患者的数据。生成未调整的Kaplan-Meier生存曲线以分析术后1年和2年的生存率。
2014年8月至2024年3月期间连续纳入10例患者。所有患者均成功进行了双侧CSD-VAT手术。术前射血分数为33%（26-41）。2例患者（22%）发生心源性休克，1例发生血管麻痹。一半（50%）的患者需要使用血管活性药物支持，1例需要使用主动脉内球囊泵。中位住院时间为12天（9-19天）。3例（33%）患者术后需要入住重症监护病房。所有患者出院时均存活。未观察到重大手术并发症或通常与VAT-CSD相关的并发症（如霍纳综合征）。1年生存率为80%，24个月生存率为60%。
CSD-VAT是难治性VT患者的一种可行的挽救治疗方法，术中及术后并发症有限，长期生存率可接受。
