Key result
VATS-guided intrathoracic left-to-right tunneling of epicardial LV leads proves safe and feasible in two patients.
Why the study?
Alternative approaches are needed for left ventricular lead implantation in patients requiring right-sided CRT-D devices when left subclavian vein access and endocardial lead placement fail.
Is intrathoracic left-to-right tunneling of an epicardial left ventricular lead by video-assisted thoracic surgery feasible and safe in patients requiring right-sided CRT-D placement?
Case Report (n=2)
Is intrathoracic left-to-right tunneling of an epicardial left ventricular lead by video-assisted thoracic surgery feasible and safe in patients requiring right-sided CRT-D placement?
Intrathoracic left-to-right tunneling of an epicardial LV lead via VATS provides a safe and feasible alternative to subcutaneous tunneling for right-sided CRT-D implantation.
May offer alternative tunneling for right-sided CRT-D in select cases; hypothesis-generating and requires prospective validation before adoption.
We describe two cases in which a biventricular implantable cardioverter defibrillator for cardiac resynchronization therapy had to be placed on the right side due to unsuitability of the left subclavian vein. Endocardial implantation of a left ventricular lead through the coronary sinus was previously attempted but was unsuccessful. Implantation of the epicardial left ventricular pacing lead was performed through video-assisted thoracic surgery on the left side. The connector end of the left ventricular pacing lead was tunnelized through the anterior mediastinum into the right pleural space. The right-sided pocket was then opened. A tunnel was created from the pocket to the thoracic wall, and the pleural space was entered over the second rib. The lead was retrieved from the right pleural space and connected with the Cardiac resynchronization therapy-device (CRT-D). Both procedures and postoperative periods were uneventful. Intrathoracic left-to-right tunneling of an epicardial left ventricular lead by video-assisted thoracic surgery is feasible and safe. It provides an alternative to subcutaneous tunneling.
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Stoker et al. (2011) conducted a case report in Need for biventricular ICD for CRT with unsuitable left subclavian vein and failed endocardial LV lead implantation (n=2). Video-assisted thoracic surgery for epicardial left ventricular pacing lead implantation with intrathoracic left-to-right tunneling was evaluated on Procedural success and postoperative safety. Intrathoracic left-to-right tunneling of an epicardial left ventricular lead by video-assisted thoracic surgery was feasible and safe in two patients.
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