title: Minimally invasive implantation of the myopore sutureless myocardial pacing lead.
abstract: Cardiac resynchronization therapy improves symptoms and survival of patients with congestive heart failure. Usually, the transvenous placement of the left ventricular lead is feasible, but in case of anatomic abnormalities of the coronary sinus, an unintended left phrenic nerve stimulation, a dislodgement of the percutaneous electrode, or a loss of capture of the electrode, surgical treatment should be considered. From January 2010 to September 2011, 15 patients underwent surgical implantation of the left ventricular lead after failure of transvenous placement. The MyoPore sutureless myocardial pacing lead (MSMPL) was implanted through a left minithoracotomy (~5 cm) under selective right lung ventilation. Time of surgery was 38.5 ± 3.0 minutes, and no surgical complications or early deaths are reported so far. After 10.7 ± 8.3 months of follow-up, no cases of late mortality, dislodgement, or loss of capture of the electrode are described. The use of the MSMPL is not novel, although the association with a minimally invasive approach may represent an alternative for a high-risk population. The screw-in of the lead ensures low impedance and threshold of stimulation (1.1 ± 0.6 V at 0.5 milliseconds) both in early and medium terms. In conclusion, in case of failure of the transvenous approach, the MSMPL may be easily implanted through a left minithoracotomy, and the results are noteworthy.
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti Papardo-Piemonte Hospital, Messina, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ceresa
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sansone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Calvagna
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Maiorana
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Busà
authors.forename: Santina
authors.initials: S
authors.lastname: Patanè
authors.forename: Rosario
authors.initials: R
authors.lastname: Evola
authors.forename: Francesco
authors.initials: F
authors.lastname: Patanè
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods; 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*; D018570:Risk Assessment; D012307:Risk Factors; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome