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 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.
Hans-Stefan
HS
Hofmann
Michael
M
Ried
Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049 Regensburg, Germany. zsolt.sziklavari@barmherzige-regensburg.de.
Zsolt
Z
Sziklavari
D000368:Aged; D002037:Bundle-Branch Block / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*