Robotic-assisted or minithoracotomy incision for left ventricular lead placement: A single-surgeon, single-center experience

Castigliano Murthy Bhamidipati, Igor W. Mboumi, Keri A. Seymour, Roberta Rolland, Karikehalli Dilip, Raja R. Gopaldas, Charles J. Lutz

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

OBJECTIVE: Left ventricular (LV) resynchronization with epicardial lead placement after failed coronary sinus cannulation can be achieved with minimally invasive robotic-assisted (RA) or minithoracotomy (MT) incisions. We evaluated early outcomes and costs after RA and MT epicardial LV lead implantation at our academic center. METHODS: From 2005 to 2010, 24 patients underwent minimally invasive RA or MT epicardial LV lead placement for resynchronization. Patient characteristics, electrophysiologic features, outcomes, and costs were analyzed. RESULTS: Ten patients underwent RA and 14 underwent MT minimally invasive LV lead placement, with no 30-day mortality in either group. Younger patients underwent RA epicardial lead placement (63.8 ± 15.4 vs 75.6 ± 10.0 years; P = 0.03). In addition, although both groups had comparable body surface areas, RA patients had significantly higher body mass index versus MT patients (44.4 ± 17.5 vs 26.9 ± 7.1 kg/m, respectively; P = 0.003). Premorbid risk and cardiovascular profiles were similar across groups. Importantly, pacing threshold, impedance, and postoperative QRS interval were equivalent between groups. Significantly, both operating room and mechanical ventilation durations were higher with RA epicardial placement (P < 0.001). Despite equivalent outcomes, incision-to-closure interval was 48 minutes shorter with MT (P = 0.002). Absolute differences in direct costs between groups were negligible. Despite these differences, resource utilization and lengths of stay were equivalent. CONCLUSIONS: Epicardial LV lead placement is efficacious with either approach. Early outcomes and mortality are equivalent. Greater tactile feedback during operation and equivalent short-term outcomes suggest that MT minimally invasive LV lead placement is the more favorable approach for epicardial resynchronization.

Original languageEnglish (US)
Pages (from-to)208-212
Number of pages5
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume7
Issue number3
DOIs
StatePublished - May 1 2012

Keywords

  • Cardiac surgery
  • Left ventricular lead implantation
  • Minithoracotomy
  • Resynchronization
  • Robotic assisted

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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