title: Alternative to left ventricular lead implantation through the coronary sinus: 1-year experience with a minimally invasive and robotically guided approach.
abstract: OBJECTIVE
  Left ventricular (LV) lead implantation through the coronary sinus (CS) can be limited and sometimes not possible-alternative approaches are needed. Minimally invasive, robotically guided LV lead implantation has major advantages, but there are little published data about the short- and long-term follow-ups, in terms of feasibility, safety, electrical performance, and impact on clinical outcome.
  
  
  RESULTS
  A total of 21 heart failure patients underwent robotically guided LV lead implantation using the Da Vinci Robotic System. Indications were failed implant with conventional approach through the CS (n = 16) and non-response to conventional cardiac resynchronization therapy (n = 5). During the procedure, the entire LV free wall was exposed through 3 transthoracic ports (10 mm diameter each) allowing ample choice of stimulation site and the ability to implant 2 LV leads via a Y connector. Patients were prospectively followed up for 1 year. The two LV leads were successfully implanted in all patients. No peri-procedural complications were observed. After a mean stay in the intensive care unit of 1.2 ± 4 days, the 21 patients were hospitalized in the EP department for 6.7 ± 2.9 days. Acute LV thresholds were excellent (1.0 V ± 0.6/0.4 ms) and stayed stable at 1-year follow-up (1.5 V ± 0.6/0.4 ms, P = 0.21). Four patients demonstrated an increased threshold (>2 V/0.4 ms). There was no phrenic nerve stimulation. After 12 months, in the failed implant group, 69% of the patients were echocardiographic and clinical responders.
  
  
  CONCLUSIONS
  The robotic approach was feasible, safe, and minimally invasive. Accordingly, robotically guided LV lead implantation seems to offer a new alternative when conventional approaches are not suitable.
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France sana.amraoui@hotmail.com.
authors.forename: Sana
authors.initials: S
authors.lastname: Amraoui
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Labrousse
authors.affiliation: Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.affiliation: Free University of Brussels (ULB), Hôpital Erasme, Brussel, Belgium.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Jansens
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berte
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.affiliation: Université de Bordeaux, Hôpital Haut-Lévêque, LIRYC, Bordeaux-Pessac 33604, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac insufficiency; Cardiac resynchronization therapy; Epicardial lead; Left ventricular lead; Minimally invasive; Robotic approach