The Annals of Thoracic Surgery, Vol 56, 312-315, Copyright © 1993 by The Society of Thoracic Surgeons
Subxiphoid approach for insertion of ICDs after previous median sternotomy
CA Marrin, CC Canver, M Greenberg, P Holzberger, SK Plume and WC Nugent
Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire.
To avoid the risks both of repeat median sternotomy and of thoracotomy, the
modified subxiphoid approach was adopted for insertion of implantable
cardioverter-defibrillators in 10 patients who had previously undergone
cardiac operations via median sternotomy. Effective implantable
cardioverter-defibrillator systems were implanted in all patients. There
were no operative deaths and no hemorrhagic or respiratory complications.
One patient underwent repositioning of a dislodged superior vena caval
electrode, and an infected generator pocket developed in 1 patient. Early
extubation was routine. Two patients were observed in the coronary care
unit for the first postoperative night. Postoperative pain was controlled
with oral analgesic agents. The subxiphoid approach is safe and effective,
and it carries a substantially lower risk of complications than other
techniques, even in this high-risk group of patients. By minimizing the
need for admission to the intensive care unit, invasive monitoring, and
prolonged ventilatory support, by reducing surgical complications, and by
shortening the hospital stay, the subxiphoid approach saved an average of
$3,295 per patient.
