Blakeman B P, Sullivan H J, Montoya A, Calandra D, Wilber D, Olshansky B, Kall J, Kopp D, Pifarré R
Loyola University Medical Center, Department of Thoracic and Cardiovascular Surgery, Maywood, Ill. 60153.
J Thorac Cardiovasc Surg. 1993 Dec;106(6):1040-6; discussion 1046-7.
Over a 2-year period, 110 patients underwent attempted implantation of an automatic cardioverter-defibrillator using the nonthoracotomy lead system. Indications included sustained monomorphic ventricular (n = 62), nonsustained with poor ventricular function (n = 7), ventricular fibrillation (n = 21), ventricular tachycardia/fibrillation (n = 18), and familial long QT syndrome (n = 2). There were 90 male and 20 female patients. Mean age was 57 +/- 15 years. Sixty percent had previous coronary bypass or valve operations, or both. Mean left ventricular ejection fraction was 30% +/- 14%, cardiac index was 2.4 +/- 0.9 L/m2, and systolic pulmonary artery pressure was 41 +/- 14 mm Hg. Under general anesthesia, the nonthoracotomy lead was introduced through the left subclavian vein. The subcutaneous patch and generator were placed posteriorly on the serratus muscle and left upper quadrant, respectively. The length of the procedure was 116 +/- 44 minutes and the mean number of defibrillation shocks for a successful implant was 8 +/- 4. Eighty-five patients (77%) had successful implantations. Failures were due to high defibrillation threshold (n = 23) and inability to place a right ventricular lead (n = 2). Predictors of failure included preoperative antiarrhythmic drugs and cardiac index of 1.8 +/- 4 L/m2 or less (p = 0.004). Three patients (2.7%) died after the operation of heart failure (n = 2) and chronic heart transplant rejection (n = 1). Complications included lead migration or dislodgment (n = 8), infection (n = 1), and hematoma (n = 3). In summary, the nonthoracotomy lead system may provide an alternative in patients undergoing cardioverter-defibrillator implantation.
在两年期间，110例患者尝试使用非开胸导联系统植入自动心脏复律除颤器。适应证包括持续性单形性室性心动过速（n = 62）、伴有心室功能不良的非持续性室性心动过速（n = 7）、心室颤动（n = 21）、室性心动过速/心室颤动（n = 18）以及家族性长QT综合征（n = 2）。患者中男性90例，女性20例。平均年龄为57±15岁。60%的患者既往有冠状动脉搭桥术或瓣膜手术，或两者都有。平均左心室射血分数为30%±14%，心脏指数为2.4±0.9L/m²，收缩期肺动脉压为41±14mmHg。在全身麻醉下，通过左锁骨下静脉插入非开胸导联。皮下贴片和发生器分别置于后锯肌和左上象限后方。手术时间为116±44分钟，成功植入时除颤电击的平均次数为8±4次。85例患者（77%）成功植入。失败原因包括除颤阈值高（n = 23）和无法放置右心室导联（n = 2）。失败的预测因素包括术前抗心律失常药物以及心脏指数为1.8±4L/m²或更低（p = 0.004）。3例患者（2.7%）术后死于心力衰竭（n = 2）和慢性心脏移植排斥反应（n = 1）。并发症包括导联移位或脱位（n = 8）、感染（n = 1）和血肿（n = 3）。总之，非开胸导联系统可能为接受心脏复律除颤器植入的患者提供一种替代方法。
