Implantation of systems for cardiac resynchronisation: tips and tricks – cardiac surgeon's view
a Department of Thoracic and Cardiovascular Surgery, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
b Department of Cardiology, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
Received 3 May 2004; accepted 24 May 2004.
* Bert Hansky, Department of Thoracic and Cardiovascular Surgery, Heart Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Tel.: +49-5731-970; fax: +49-5731-971820
bhansky{at}hdz-nrw.de
Abstract
Specific problems of cardiosurgical implantation of biventricular devices for cardiac resynchronisation therapy are elucidated elaborately. In particular, the necessity and amount of intraoperative monitoring as well as the appropriate mode of anaesthesia are described. Furthermore, the sequence of lead placement, the technique of coronary sinus intubation using a guiding catheter as well as means to avoid thrombus formation in the coronary sinus are depicted.
Biventricular ICD devices should be implanted from a left sided approach to integrate the device into the defibrillation field and to maintain the option of placing an additional subcutaneous array lead.
It is of particular cardiosurgical interest that coronary vein leads are applicable for ventricular stimulation in patients after tricuspid valve replacement thus avoiding repeated surgical exposure of the heart.
Key Words: Cardiac resynchronisation therapy • Biventricular ICD • Surgical technique • Tricuspid valve replacement