title: Robotic-assisted or minithoracotomy incision for left ventricular lead placement: a single-surgeon, single-center experience.
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.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY 13210, USA.
authors.forename: Castigliano Murthy
authors.initials: CM
authors.lastname: Bhamidipati
authors.forename: Igor W
authors.initials: IW
authors.lastname: Mboumi
authors.forename: Keri A
authors.initials: KA
authors.lastname: Seymour
authors.forename: Roberta
authors.initials: R
authors.lastname: Rolland
authors.forename: Karikehalli
authors.initials: K
authors.lastname: Dilip
authors.forename: Raja R
authors.initials: RR
authors.lastname: Gopaldas
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lutz
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D013908:Thoracotomy / Q000379:methods*