Key result
The subaxillary approach for cardiac device implantation resulted in 0 procedural complications, 0 deaths, and 0 infections over a mean follow-up of 65 months in 23 young adults.
Why the study?
Is the subaxillary approach for cardiac device implantation safe, feasible, and aesthetically satisfactory in young adults?
Observational (n=23)
No
Is the subaxillary approach for cardiac device implantation safe, feasible, and aesthetically satisfactory in young adults?
The subaxillary approach for cardiac device implantation is a feasible and safe alternative that offers excellent aesthetic results for young adults.
Supports feasibility and satisfaction in this small series; hypothesis-generating, requiring prospective trials before wider use.
OBJECTIVES: Pacemakers and implantable cardioverter defibrillators have become more common in younger individuals, owing to broader indications and technological advances. Our goal was to report our long-term experience of implanting cardiac devices in young adults via a subaxillary approach with a hidden single incision, to minimize the aesthetic impact of the device. METHODS: From 2003 to 2012, 23 patients underwent cardiac device implantation via a subaxillary approach while they were under general anaesthesia. The axillary vein was punctured under contrast-medium radiological guidance. The devices were positioned into the pocket under the pectoralis major muscle and over the fascia that envelopes the pectoralis minor muscle, through a lateral surgical access along the midaxillary line. RESULTS: Twenty-two single- and dual-chamber implantable cardioverter defibrillator and 1 dual-chamber pacemaker were implanted (mean age 32.2 ± 13.4 years). All procedures were successfully performed without complications; overall hospitalization after implantation was 3.3 days. During mean a follow-up of 65 ± 18 months, no deaths, infections or device migrations occurred. Two ventricular lead dislodgements requiring repositioning occurred within 1 month, and 1 defibrillation lead fracture occurred 5 years after implantation. All patients were extremely satisfied with the aesthetic result. A mild increase in the pacing threshold (0.88 ± 0.6 V at 0.4/0.5 ms at implantation vs 1.00 ± 0.3 V at 0.4/0.5 ms at 2-year follow-up, P = 0.063) and a statistically significant decrease in the pacing impedance (637 ± 161 ohm at implantation vs 499 ± 81 ohm at 2-year follow-up, P = 0.001) were observed, without any consequences. CONCLUSIONS: The subaxillary approach is a safe, feasible technique that requires a simple surgical procedure. The implantable cardioverter defibrillator functions properly at implantation and at long-term follow-up.
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Bolzan et al. (2018) conducted an observational in Need for cardiac electronic device implantation (n=23). Subaxillary approach to cardiac electronic device implantation was evaluated on Procedural complications and long-term device function. The subaxillary approach for cardiac device implantation resulted in 0 procedural complications, 0 deaths, and 0 infections over a mean follow-up of 65 months in 23 young adults.
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