Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome

Abstract

Background Epicardial placement of the left ventricular (LV) lead via a video‐assisted thoracoscopic (VAT) approach is an alternative to the standard transvenous technique. Hypothesis Long‐term safety and efficacy of VAT and transvenous LV lead implantation are comparable. To test it, we reviewed our experience and we compared the outcomes of patients who underwent implantation with the two techniques. Methods The VAT procedure is performed under general anesthesia, with oro‐tracheal intubation and right‐sided ventilation, and requires two 5 mm and one 15 mm thoracoscopic ports. After pericardiotomy at the spot of the epicardial target area, pacing measurements are taken and a spiral screw electrode is anchored at the final pacing site. The electrode is then tunneled to the pectoral pocket and connected to the device. Results 105 patients were referred to our center for epicardial LV lead implantation. After pre‐operative assessment, 5 patients were excluded because of concomitant conditions precluding surgery. The remaining 100 underwent the procedure. LV lead implantation was successful in all patients (median pacing threshold 0.8 ± 0.5 V, no phrenic nerve stimulation) and cardiac resynchronization therapy was established in all but one patient. The median procedure time was 75 min. During a median follow‐up of 24 months, there were no differences in terms of death, cardiovascular hospitalizations or device‐related complications vs the group of 100 patients who had undergone transvenous implantation. Patients of both groups displayed similar improvements in terms of ventricular reverse remodeling and functional status. Conclusions Our VAT approach proved safe and effective, and is a viable alternative in the case of failed transvenous LV implantation.

Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy

“…In contrast, our data revealed that the VATS epicardial LV lead implantation without sternotomy showed satisfactory and comparable long-term (34.3 ± 28.6 months) outcomes with regards to LV lead performance, electro-/echocardiographic improvement, and clinical prognosis of patients compared with those using a conventional endocardial approach. Our results are in line with data from Marini et al, who demonstrated no differences in death, cardiovascular hospitalizations, or devicerelated complications between the Epicardial (thoracoscopically implanted) and Endocardial groups during a median followup of 24 months 19 .…”

“…However, most of the previous data were derived from patients treated by sternotomy or thoracotomy, which is more invasive treatment than thoracoscopic surgery 9,10,17 . Although a small number of studies were carried out on thoracoscopic epicardial LV lead implantation, the e cacy of CRT using the VATS approach was not compared using endocardial LV leads; if ever compared, only for a short period (6-12 months) 18, 19 .…”

A Hybrid Procedure Combining Mini-Thoracotomy with Interventional Endocardial Lead Implantation for Cardiac Resynchronization Therapy in Patients with Chronic Congestive Heart Failure: A Report of Four Cases

“…In conclusion, during CRT, epicardial lead implantation via minimally invasive left-sided thoracotomy is safe, feasible, and effective. Our findings corroborate those of Marini et al, who reported a similar length of hospital stay, complication rate, and improvement in ventricular reverse remodeling and functional status between patients undergoing epicardial placement of the left ventricular lead using a video-assisted thoracoscopic technique and those undergoing the standard transvenous technique [Marini 2020].…”

Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients—An Experience-Based Narrative Review

“…Recently emerging minimally invasive surgical implantation techniques, like minithoracotomy, video thoracoscopy, and robotic surgery, reduce the risk of sterno-and thoracotomy, and allow all pacing modes, including resynchronization therapy [40][41][42][43]. Efficacy and mortality were usually comparable to patients with endocardial implanted systems, especially if steroid-eluting epicardial leads were used [44,45].…”