医学
心力衰竭
心脏再同步化治疗
开胸手术
心脏病学
膈神经
外科
肋间间隙
铅(地质)
内科学
射血分数
地貌学
地质学
呼吸系统
作者
Haiyan Xiang,Rifeng Gao,Juesheng Yang,Juxiang Li,Jin Li,Fei Lu,Yanhua Tang
出处
期刊:Heart Surgery Forum
[Carden Jennings Publishing Co.]
日期:2020-08-31
卷期号:23 (5): E627-E631
摘要
Background: We describe the application and effectiveness of transthoracic electrode implantation for epicardial left ventricular pacing in cardiac resynchronization therapy (CRT) for patients with chronic congestive heart failure. Methods: We assessed four patients with chronic congestive heart failure for whom implantation of endocardial electrodes was contraindicated. The epicardial electrodes were implanted via a mini-thoracotomy in the fourth or fifth left intercostal space. We analyzed the surgical implantation technique and the short-term effectiveness of the procedure. Results: The epicardial electrodes successfully were implanted in all four patients. The patients’ hemodynamic status, cardiac function, and symptoms significantly improved. Patients I, II, III, and IV were discharged from the hospital on the 8, 11, 4, and 7 days, respectively, after the operation. Follow up lasted for 12 months. None of the patients presented with electrode fractures or surgical wound infections, and the pacing threshold and electrode impedance were normal. In one case, phrenic nerve stimulation occurred due to the low placement position of the electrode. When the electrode was moved slightly inward and upward, the sacral nerve stimulation sign disappeared, and no other complications were noted. One patient developed capsule infection, and the presence of an ectopic pacemaker was noted; therefore, a pacemaker replacement procedure was required. Conclusion: In CRT, the implantation of a left ventricular epicardial electrode through a left-sided small incision is safe, feasible, and effective. This hybrid surgery combining interventional and cardiac techniques can maximize the curative effect of CRT.
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