Robotic-enhanced biventricular resynchronization:: An alternative to endovenous cardiac resynchronization therapy in chronic heart failure
Robotic-enhanced biventricular resynchronization:: An alternative to endovenous cardiac resynchronization therapy in chronic heart failure
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DOI：
10.1016/s0003-4975(03)00435-1
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发表时间：
2003-08-01
影响因子：
4.6
通讯作者：
de Cannière, D
中科院分区：
文献类型：
--
作者：
Jansens, JL;Jottrand, M;de Cannière, D
背景通过起搏左心室和右心室的心脏起搏治疗（CRT）是治疗严重心力衰竭伴心室传导障碍的新兴选择。通过冠状静脉的刺激是目前实现左心室（LV）起搏的首选技术。不幸的是，这种方法具有显著的局限性和缺点。因此，我们探索了机器人增强胸腔镜植入心外膜电极导线作为心脏起搏治疗中刺激LV的替代技术。本研究共纳入15例患者。右（心房和心室）电极导线通过左锁骨下静脉传统植入。然后进行机器人增强胸腔镜检查以植入左心室心外膜电极导线。在15名患者中，13名患者成功接受了内窥镜机器人心脏消融治疗。2例患者转为小开胸术。未中转开腹的患者无围手术期并发症发生。所有患者的急性和慢性LV电极导线阈值均令人满意，并随时间推移而改善。所有患者在4个月时主观和客观上均得到改善。与传统方法相比，手术费用没有显着影响。基于该可行性研究，我们认为机器人左心室心外膜电极导线植入是实现双心室起搏治疗的一种有价值的选择。与经皮方法相比，其允许LV起搏和感知的可再现急性阈值更多;能够微调LV电极导线位置，从而可能提供最佳血流动力学受益，并避免静脉内方法的缺陷和局限性。因此，它值得进一步的前瞻性研究，以评估其在治疗心力衰竭的医疗设备。(C)2003年由胸外科医师协会发布。
Background. Cardiac resynchronization therapy (CRT) by pacing the left and right ventricles is an emerging option for treatment of severe heart failure with ventricular conduction disturbances. Stimulation through a coronary vein is currently the technique of choice to achieve left ventricular (LV) pacing. Unfortunately, this approach carries significant limitations and drawbacks. Therefore we explored robotic-enhanced thoracoscopic implantation of an epicardial lead as an alternative technique to stimulate the LV in cardiac resynchronization therapy.Methods. A total of 15 patients were included in this study. Right (atrial and ventricular) leads were implanted classically through the left subclavian vein. Robotic-enhanced thoracoscopy was then performed to implant the LV epicardial lead.Results. Of the 15 patients, 13 underwent successful endoscopic robotic cardiac resynchronization therapy. Two patients underwent conversion to a small thoracotomy. No perioperative complication occurred in the patients who did not undergo conversion. Acute and chronic LV lead thresholds were satisfactory in all patients, improving over time. All were subjectively and objectively improved at 4 months. As compared with conventional methods, the procedural cost was not significantly affected.Conclusions. Based on this feasibility study, we believe that robotic LV epicardial lead implantation is a valuable option to achieve biventricular resynchronization therapy. It allows for more reproducible acute thresholds for LV pacing and sensing than does the percutaneous approach; enables fine tuning of the LV lead position, thus potentially providing optimal hemodynamic benefit, and avoids the pitfalls and limitations of the endovenous approach. Therefore it deserves further prospective studies to assess its place in the therapeutic armamentarium against heart failure. (C) 2003 by The Society of Thoracic Surgeons.