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Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion

BACKGROUND: In cases of intravenous placement failure of the left ventricular (LV) lead for cardiac resynchronisation therapy (CRT) and obliteration of the left pleural space, the alternative approach of transthoracic placement by video-assisted thoracoscopic surgery (VATS) is difficult and not comm...

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Autores principales: Hofmann, Hans-Stefan, Ried, Michael, Sziklavari, Zsolt
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017962/
https://www.ncbi.nlm.nih.gov/pubmed/24721196
http://dx.doi.org/10.1186/1749-8090-9-70
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author Hofmann, Hans-Stefan
Ried, Michael
Sziklavari, Zsolt
author_facet Hofmann, Hans-Stefan
Ried, Michael
Sziklavari, Zsolt
author_sort Hofmann, Hans-Stefan
collection PubMed
description BACKGROUND: In cases of intravenous placement failure of the left ventricular (LV) lead for cardiac resynchronisation therapy (CRT) and obliteration of the left pleural space, the alternative approach of transthoracic placement by video-assisted thoracoscopic surgery (VATS) is difficult and not commonly practiced. METHODS: Here, we present a simple technique for transthoracic introduction of an epicardial LV lead using a wound retractor (ALEXIS®) in a patient with heart failure. This wound retractor enables atraumatic tissue retraction without rib spreading, an optimal direct view in the pleural space for surgical pleurolysis and a high degree of safety for the patient. RESULTS: No perioperative complications occurred. The tube drainage was removed on the second postoperative day, and the patient was discharged on the third postoperative day. CONCLUSIONS: The decided advantage of this new method is the lack of any need for rib spreading using a mechanical retractor. Especially in patients with a history of open-heart surgery (including internal mammary artery bypass grafting and/or revascularisation of the left lateral wall) or known pleural adhesions (e.g., pleuritis or lung operations), the described technique provides a rapid and save access with minimal surgical effort and greater safety.
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spelling pubmed-40179622014-05-13 Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion Hofmann, Hans-Stefan Ried, Michael Sziklavari, Zsolt J Cardiothorac Surg Research Article BACKGROUND: In cases of intravenous placement failure of the left ventricular (LV) lead for cardiac resynchronisation therapy (CRT) and obliteration of the left pleural space, the alternative approach of transthoracic placement by video-assisted thoracoscopic surgery (VATS) is difficult and not commonly practiced. METHODS: Here, we present a simple technique for transthoracic introduction of an epicardial LV lead using a wound retractor (ALEXIS®) in a patient with heart failure. This wound retractor enables atraumatic tissue retraction without rib spreading, an optimal direct view in the pleural space for surgical pleurolysis and a high degree of safety for the patient. RESULTS: No perioperative complications occurred. The tube drainage was removed on the second postoperative day, and the patient was discharged on the third postoperative day. CONCLUSIONS: The decided advantage of this new method is the lack of any need for rib spreading using a mechanical retractor. Especially in patients with a history of open-heart surgery (including internal mammary artery bypass grafting and/or revascularisation of the left lateral wall) or known pleural adhesions (e.g., pleuritis or lung operations), the described technique provides a rapid and save access with minimal surgical effort and greater safety. BioMed Central 2014-04-10 /pmc/articles/PMC4017962/ /pubmed/24721196 http://dx.doi.org/10.1186/1749-8090-9-70 Text en Copyright © 2014 Hofmann et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hofmann, Hans-Stefan
Ried, Michael
Sziklavari, Zsolt
Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion
title Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion
title_full Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion
title_fullStr Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion
title_full_unstemmed Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion
title_short Minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion
title_sort minimally invasive epicardial left ventricular lead placement in a case of massive pleural adhesion
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017962/
https://www.ncbi.nlm.nih.gov/pubmed/24721196
http://dx.doi.org/10.1186/1749-8090-9-70
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