Key result
A hybrid procedure combining mini-thoracotomy with interventional endocardial lead implantation was successfully performed in 4 patients, improving hemodynamics, cardiac function, and clinical symptoms.
Why the study?
The authors investigated the application and outcomes of a hybrid CRT procedure combining left ventricular epicardial lead implantation via mini-thoracotomy with interventional endocardial lead implantation in chronic heart failure.
Does a hybrid procedure combining mini-thoracotomy with interventional endocardial lead implantation improve outcomes in patients with chronic heart failure unsuitable for transvenous LV lead implantation?
Case Report (n=4)
No
Does a hybrid procedure combining mini-thoracotomy with interventional endocardial lead implantation improve outcomes in patients with chronic heart failure unsuitable for transvenous LV lead implantation?
A hybrid procedure combining mini-thoracotomy for epicardial LV lead placement with transvenous endocardial leads is a feasible and effective alternative for CRT in patients with heart failure who cannot undergo standard transvenous LV lead implantation.
Answers are grounded in this paper and cite their sources.
Hybrid CRT via mini-thoracotomy appears feasible in select patients; leaves open safety, efficacy, and durability for larger prospective trials.
We investigated the application and outcomes of a hybride procedure combining left ventricular epicardial lead implantation via mini-thoracotomy with interventional endocardial lead implantation for cardiac resynchronization in the treatment of chronic heart failure. Epicardial lead implantation was applied via a small left-sided chest incision through the fourth or fifth intercostal space in 4 patients with chronic heart failure who were not suitable for left ventricular endocardial lead implantation. The surgical technique of epicardial lead implantation and its short-term outcomes were analyzed. Epicardial lead implantation was successfully performed in all 4 patients, with significant postoperative improvements in hemodynamics, cardiac function and clinical symptoms. 4 Patients were discharged 8, 11, 4 and 7 days after surgery respectively and followed for 12 months. No lead breakage or wound infection were found on followup. The pacing threshold and lead impedance were normal. Phrenic nerve irritation was observed in one patient because the lead was placed lower than that of other three patients but improved obviously after lowering the threshold. No other complications were observed. In conclusion, trans-thoracic left ventricular epicardial lead implantation is a safe, feasible and effective method for cardiac resynchronization therapy. A hybrid procedure combining the interventional endocardial lead implantation with minithoracotomy may maximize CRT outcomes and can be widely applied.
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Yanhua Tang (2019) conducted a case report in Chronic congestive heart failure (n=4). Hybrid procedure combining mini-thoracotomy with interventional endocardial lead implantation was evaluated on Procedural success and improvement in cardiac function. A hybrid procedure combining mini-thoracotomy with interventional endocardial lead implantation was successfully performed in 4 patients, improving hemodynamics, cardiac function, and clinical symptoms.
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