title: Limited thoracotomy as a second choice alternative to transvenous implant for cardiac resynchronisation therapy delivery.
abstract: OBJECTIVE
  Left ventricular (LV) pacing via transvenous implantation has an overall success rate ranging from 88% to 92%. The aim of this study was to assess whether LV pacing via limited thoracotomy would be feasible and safe when used on a routine basis for those cases in which standard transvenous procedures proved to be ineffective or unsatisfactory.
  
  
  RESULTS
  We enrolled 33 patients (8 females, 65+/-10 years) who experienced a transvenous implantation failure. All patients underwent a limited thoracotomy and an epicardial lead was implanted. The procedure time was 51+/-28 min. No surgical or post-operative complications occurred and optimal lateral position was achieved for all patients. In the 12 months follow-up period, 5 patients died from refractory heart failure, the remaining patients did not experience complications. At implant, the mean pacing threshold was 1.3+/-0.7 V, bi-ventricular pacing impedance was 476+/-201 Omega and R-wave amplitude was 15.0+/-6.1 mV. No significant differences were found in any of the electrical parameters between baseline and follow-up. Significant improvement was observed in functional and echocardiographic parameters.
  
  
  CONCLUSIONS
  Our results suggest that a combined approach to cardiac resynchronisation therapy delivery, including a transvenous attempt followed by a back up thoracotomic procedure, could potentially guarantee the success.
authors.affiliation: Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy. puglisandrea@hotmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Puglisi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Antonino G M
authors.initials: AG
authors.lastname: Marullo
authors.forename: Stefano
authors.initials: S
authors.lastname: Bianchi
authors.forename: Mariano
authors.initials: M
authors.lastname: Feccia
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sgreccia
authors.forename: Ilaria
authors.initials: I
authors.lastname: Vicini
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
authors.forename: Ettore
authors.initials: E
authors.lastname: Vitali
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy; D002303:Cardiac Output, Low / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004567:Electrodes, Implanted; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D010138:Pacemaker, Artificial; D013908:Thoracotomy / Q000379:methods*