Robotic-Assisted or Minithoracotomy Incision for Left Ventricular Lead Placement a Single-Surgeon, Single-Center Experience

Robotic-Assisted Left Ventricular Lead Placement

Robot-assisted left ventricular lead implantation for cardiac resynchronization therapy is a feasible and safe technique with superior visualization, dexterity, and precision to target the optimal pacing site. The technique has been associated with clinical response and beneficial reverse remodeling comparable with the conventional approach via the coronary sinus. The lack of clinical superiority and a residual high nonresponder rate suggest that the appropriate clinical role for the technique remains as rescue therapy.

Robotic-Assisted Left Ventricular Lead Placement

Robot-assisted left ventricular lead implantation for cardiac resynchronization therapy is a feasible and safe technique with superior visualization, dexterity, and precision to target the optimal pacing site. The technique has been associated with clinical response and beneficial reverse remodeling comparable with the conventional approach via the coronary sinus. The lack of clinical superiority and a residual high nonresponder rate suggest that the appropriate clinical role for the technique remains as rescue therapy.

Minimally invasive thoracoscopic technique for cardiac resynchronization therapy

Outcome of surgical left ventricular (LV) lead placement is not well defined in patients with failed percutaneous cardiac resynchronization therapy. An extended experience with epicardial LV lead placement is here reported, describing the minimally invasive procedure performed at our institution using a thoracoscopic surgical approach.

Robotic left ventricular epicardial lead positioning

Cardiac resynchronization therapy is indicated in advanced heart failure patients with a wide QRS complex, because it restores the synchronicity of the atrioventricular, interventricular and intraventricular contractions. It is performed through endovascular implantation of one or more leads. Left cardiac lead positioning is one of the most challenging procedures in interventional cardiology; unfortunately, in up to 40% of cases no clinical improvements occur. Surgical implantation of a left ventricular lead is indicated in cases of failure or predicted unfeasibility of a transvenous positioning. Several surgical techniques have been described for implantation of left ventricular lead. Minimally invasive approaches, including video-assisted thoracic and robotic surgery, are favoured due to reduced trauma, pain and recovery time. Robotic surgery confers significant advantages for visualization and manoeuverability, which are important in patients with a history of cardiac surgery, in whom scarring and adhesions may render placement challenging. We describe here the surgical technique for robotic implantation of left ventricular leads in candidates for cardiac resynchronization therapy.

Video-assisted thoracic placement of epicardial leads

Cardiac resynchronization therapy is one of the cornerstones of heart failure treatment. Inability to access the coronary sinus or one of its sidebranches is one of the most common causes of therapeutic failure. We describe a technique using video-assisted thoracic surgery for epicardial placement of the left ventricular lead and use an intrathoracic route to connect the lead to the device.