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The Annals of Thoracic Surgery, Vol 53, 978-983, Copyright © 1992 by The Society of Thoracic Surgeons

ARTICLES

Implantation of cardioverter defibrillators in the post-sternotomy patient

RJ Damiano Jr, AH Foster, KA Ellenbogen, MA Wood, BS Stambler, WJ Welch and AS Wechsler
Division of Cardiothoracic Surgery, Medical College of Virginia, Richmond 23298.

In an attempt to minimize the hazards of redo sternotomy or thoracotomy in patients who have undergone previous cardiac procedures, a technique has been developed for cardioverter defibrillator implantation that involves dissection through a left subcostal incision and placement of extrapericardial defibrillation patches. This approach was used in 22 consecutive patients who required an implantable cardioverter defibrillator 4 to 156 months after previous median sternotomy. Defibrillation threshold energy was less than or equal to 20 J in every patient. Ninety-one percent of patients were extubated during the first 24 hours and were transferred out of the intensive care unit by the second postoperative day. One patient died of an acute myocardial infarction 3 days postoperatively (1/22, 4.5%). It was necessary to replace one lead for mechanical failure of an adapter, one patch required repositioning, and 1 patient needed drainage of a persistent pleural effusion (3/22, 13.6%). No further complications occurred during 3 to 27 months of follow-up. Advantages of the subcostal approach included prompt extubation, a single incision, and minimal morbidity. This approach is safe and effective, and is the method of choice for implantation of a cardioverter defibrillator in patients who have undergone prior sternotomy.

This article has been cited by other articles:

				J. S. Lawton, K. A. Ellenbogen, M. A. Wood, B. S. Stambler, J. A. Spratt, A. S. Wechsler, and R. J. Damiano Jr Clinical Experience With Nonthoracotomy Cardioverter Defibrillators Ann. Thorac. Surg., May 1, 1995; 59(5): 1092 - 1098. [Abstract] [Full Text]