Comparison of three cardioverter defibrillator implantation techniques: initial results with transvenous pectoral implantation.
A total of 121 patients underwent epicardial (n = 32), transvenous abdominal (n = 30), and transvenous pectoral (n = 59) ICD implants. Perioperative complications were defined as those occurring within 30 days after surgery. Hospital costs were calculated with $750 per day as a fixed charge. Duration of surgery was the time between the first skin incision and the last skin suture. Severe perioperative complications that were life-threatening or required surgical intervention occurred in the epicardial (6%) and transvenous (10%) abdominal groups, but not in the pectoral group. Perioperative mortality occurred only in the epicardial abdominal group, predominantly in patients with concomitant surgery (18%), and in 5% of patients without concomitant surgery. The duration of surgery was significantly shorter for transvenous pectoral implantation (58 +/- 15 min, P < 0.05) compared to transvenous abdominal implantation (115 +/- 38 min). Epicardial abdominal ICD implantation had the longest procedure time (154 +/- 31 min). The postimplant hospital length of stay was significantly shorter for pectoral implantation (5 +/- 3 days, P < 0.05) compared to transvenous (13 +/- 5) and epicardial (19 +/- 5) abdominal implantation. Total hospitalization costs significantly decreased in the pectoral implantation group ($4,068 +/- $2,099 for the pectoral group vs $14,887 +/- $4,415 and $9,975 +/- $3,657 for the epicardial and the transvenous abdominal group, respectively, P < 0.05). These initial results demonstrate the advantage of transvenous pectoral ICD implantation in terms of perioperative complications, procedure time, hospital length of stay, and hospitalization costs.
Anvari
A
A
Department of Cardiology, University of Vienna, Austria.
Stix
G
G
Grabenwöger
M
M
Schneider
B
B
Türel
Z
Z
Schmidinger
H
H
D000009:Abdominal Muscles / Q000601:surgery; D017147:Defibrillators, Implantable / Q000191:economics; D004567:Electrodes, Implanted; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000601:surgery*; D010496:Pericardium / Q000601:surgery; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000628:therapy*; D013908:Thoracotomy; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000628:therapy*