SURGICAL ASPECTS OF NONTHORACOTOMY IMPLANTATION OF CARDIOVERTER - DEFIBRILLATOR SYSTEMS








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SURGICAL ASPECTS OF NONTHORACOTOMY IMPLANTATION OF CARDIOVERTER - DEFIBRILLATOR SYSTEMS
S. Ostapczuk, R. Hoeltgen1, M. Wieczorek1, A. Krian
Clinic for Thoracic and Cardiovascular Surgery; 1Clinic for Cardiology, Heart Centre Duisburg, Germany

Implantable cardioverter - defibrillators /ICD/ with nonthoractotomy lead systemshave played an increasing role to prevent death in patients with malignant ventricular arrhtythmias. This study reviews from the surgical point of view, thecases of 143 patients who underwent insertion of an ICD with nonthoracotomy lead system.
MATERIAL AND METHODS: From November 30, 1992, to November 30, 1997, 143 ICD devices were implanted at the Clinic for Thoracic and Cardiovascular Surgery, Heart Centre Duisburg. There 125 men and 18 women with a mean age of 59, 5 years (± 13,7), range: 28 to 73 years. The average preoperative ejection fraction was less than 20% in 31 patients. All implantations were performed under general anesthesia in a cardiosurgical operating room by a cardiosurgeon.
RESULTS: The nonthoracotomy lead with an ICD was successfully implanted in all patients. All patients were extubated directly after the ICD implantation in the operating room. The mean procedure duration was 74 min (± 21min). when a subcutaneous patch was used (n=13), the procedure duration was 117 min (± 18 min). in 130 patients the lead implantations were entirely transvenous. In 13 patients implantation of an additional subcutaneous patch or array electrode was necessary. In 21 patients the ICD device was implanted in an abdominal pocket and in 122 in subpectoral pocket. Complications occurred in 15 patients; 8 had lead dislogements, 6 developed a large pocket haematoma and 1 developed pocket erosion. No procedure - related deaths occurred in any patients.
CONCLUSIONS: The nonthoracotomy implantation of cardioverter - defibrillator systems is simple, safe and associated with a high success rate. The biphasic shock waveform and decreasing can size will facilitate pectoral insertion with of the implantation time.


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