Brooks R, Garan H, Torchiana D, Vlahakes G J, Dziuban S, Newell J, McGovern B A, Ruskin J N
Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston.
Am J Cardiol. 1994 Nov 15;74(10):1011-5. doi: 10.1016/0002-9149(94)90850-8.
To date, no long-term clinical data have been published in patients undergoing a nonthoracotomy approach to cardioverter-defibrillator system implantation. In the present report, 189 consecutive patients prospectively underwent a standardized approach to cardioverter-defibrillator system implantation in which the nonthoracotomy configurations were tested first. If satisfactory defibrillation thresholds were not obtained, thoracotomy was performed during the same intraoperative session. A nonthoracotomy system was successfully implanted in 149 of 189 patients (79%), with a higher success rate (90%) observed in patients who had more recent implantations. The overall rate of complications associated with these systems was low (11%). Over a mean follow-up of 12.5 +/- 9.3 months, 17 patients (9%) died. Three-year total, cardiac, and sudden death-free actuarial survival for all patients was 83 +/- 11%, 88 +/- 7%, and 94 +/- 2%, respectively. Three-year sudden death-free actuarial survival was higher in the nonthoracotomy than in the thoracotomy patients (97 +/- 2% vs 87 +/- 6%, p = 0.047), although total survival was similar (77 +/- 11% vs 83 +/- 7%, p = 0.77). These data suggest that a majority of patients (> 80%) requiring a cardioverter-defibrillator system can undergo implantation using a nonthoracotomy approach. Patients receiving nonthoracotomy systems have 3-year outcomes comparable to those implanted via thoracotomy. If these results are maintained, a nonthoracotomy approach will supplant thoracotomy-implanted systems as the preferred method because of the simpler implant procedure and lower overall cost involved.
迄今为止，尚未有关于采用非开胸方法植入心脏复律除颤器系统患者的长期临床数据发表。在本报告中，189例连续患者前瞻性地接受了心脏复律除颤器系统植入的标准化方法，其中首先测试非开胸配置。如果未获得满意的除颤阈值，则在同一手术过程中进行开胸手术。189例患者中有149例（79%）成功植入非开胸系统，近期植入患者的成功率更高（90%）。与这些系统相关的总体并发症发生率较低（11%）。在平均12.5±9.3个月的随访期内，17例患者（9%）死亡。所有患者的三年总生存率、心脏生存率和无猝死生存率分别为83±11%、88±7%和94±2%。非开胸患者的三年无猝死生存率高于开胸患者（97±2%对87±6%，p = 0.047），尽管总生存率相似（77±11%对83±7%，p = 0.77）。这些数据表明，大多数需要心脏复律除颤器系统的患者（>80%）可以采用非开胸方法进行植入。接受非开胸系统的患者三年预后与通过开胸植入的患者相当。如果这些结果得以维持，非开胸方法将因其植入过程更简单且总体成本更低而取代开胸植入系统成为首选方法。
