Project description:Atrial fibrillation is a challenging pathologic process. There continues to be a great need for the development of a reproducible, durable cure when medical management has failed. An effective, minimally invasive, sternal-sparing intervention without the need for cardiopulmonary bypass is a promising treatment approach. In this article, we describe a hybrid technique being refined at our center that combines a thoracoscopic epicardial surgical approach with an endocardial catheter-based procedure. We also discuss our results and review the literature describing this unique treatment approach.

| S-EPMC4847967 | biostudies-other

The effectiveness of rigid pericardial endoscopy for minimally invasive minor surgeries: cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation.

Project description:BackgroundThe efficacy and safety of rigid pericardial endoscopy as the promising minimally invasive approach to the pericardial space was evaluated. Techniques for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were developed.MethodsTwo swine and 5 canines were studied to evaluate the safety and efficacy of rigid pericardial endoscopy. After a double pericardiocentesis, a transurethral rigid endoscope was inserted into the pericardial space. The technique to obtain a clear visual field was examined, and acute complications such as hemodynamic changes and the effects on intra-pericardial pressure were evaluated. Using custom-made needles, pacemaker leads, and forceps, the applications for cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation were also evaluated.ResultsThe use of air, the detention of a stiff guide wire in the pericardial space, and the stretching of the pericardium with the rigid endoscope were all useful to obtain a clear visual field. A side-lying position also aided observation of the posterior side of the heart. As a cell transplantation methodology, we developed an ultrasonography-guided needle, which allows for the safe visualization of transplantation without major complications. Pacemaker leads were safely and properly implanted, which provides a better outcome for cardiac resynchronizing therapy. Furthermore, the success of clear visualization of the pulmonary veins enabled us to perform epicardial ablation.ConclusionsRigid pericardial endoscopy holds promise as a safe method for minimally invasive cell transplantation, epicardial pacemaker lead implantation, and epicardial ablation by allowing clear visualization of the pericardial space.

| S-EPMC3541994 | biostudies-literature

Minimally invasive ventricular assist device implantation.

Project description:Durable mechanical circulatory support (MCS) systems are established therapy option in patients with end-stage heart failure, with increasing importance during the last years due to donor organ shortage. Left ventricular assist devices (LVADs) are traditionally implanted through median sternotomy (MS). However, improvement in the pump designs during the last years led to evolvement of new surgical approaches that aim to reduce the invasiveness of the procedure. Numerous reports and studies have shown the viability and possible advantages of less-invasive approach compared to the sternotomy approach. The less invasive implant strategies for LVADs, while vague in definition, are characterized by minimizing surgical trauma and if possible, cardio-pulmonary bypass related complications. Usually it involves minimizing or completely avoiding sternal trauma, avoiding heart luxation while simultaneously leaving the major part of pericardium intact. There is no consensus between the centers regarding the ideal approach for LVAD implantation. Some centers, like our center, perform by default VAD implantation using less invasive approach in almost all patients and some centers use only sternotomy approach. The aim of this review article is to shed light on the currently available less invasive options of LVAD implantation, with particular focus on the centrifugal pumps, and their possible advantages compared to traditional sternotomy approach.

| S-EPMC8024790 | biostudies-literature

Recurrent pericardial effusion and tamponade after epicardial pacemaker lead placement: a case report.

Project description:BackgroundEpicardial pacemaker placement is often necessary in pacemaker-dependent patients with ongoing device pocket infection or lack of venous access. Pericardial effusion and tamponade are rare but serious complications of this procedure.Case summaryA 38-year-old woman presented with nausea, diaphoresis, and hypotension 7 days after epicardial lead placement. Echocardiography revealed a large pericardial effusion with signs of tamponade. Despite initial improvement after pericardiocentesis, she continued to develop symptomatic pericardial effusions. The patient ultimately underwent pleuro-pericardial window surgery, which resulted in sustained resolution of effusion recurrence.DiscussionCases of recurrent pericardial effusion and tamponade following epicardial lead placement have been reported in the literature, although they are rare. While extensive partial pericardiectomy or total pericardiectomy was required to achieve adequate control of fluid accumulation in prior case reports, our patient was successfully managed with a pleuro-pericardial window.

| S-EPMC9149784 | biostudies-literature

Minimally invasive surgery for placement of a subcutaneous EEG implant.

Project description:BackgroundA new class of subcutaneous electroencephalography has enabled ultra long-term monitoring of people with epilepsy. The objective of this paper is to describe surgeons' experiences in an early series of implantations as well as discomfort or complications experienced by the participants.MethodsWe included 38 implantation procedures from two trials on people with epilepsy and healthy adults. Questionnaires to assess surgeons' and participants' experience were analyzed as well as all recorded adverse events occurring up to 21 days post-surgery.ResultsWith training, the implantation could be performed in approximately 15 min. Overall, the implantation procedure was considered easy to perform with only 2 episodes where the implant got fixated in the introducing needle and a new implant had to be used. The explantation procedure was considered effortless. In 2 cases the silicone sheath covering the lead was damaged during the explantation, but it was possible to remove the entire implant without leaving any foreign body under the skin. Especially in the trial on healthy participants, a proportion experienced adverse events in the form of headache or implant-pain up to 21 days post-operatively. In 6 cases, adverse events contributed to the decision to explant and discontinue the study: Four of these cases involved implant pain or headache; One case involved a post-operative local infection; and in one case superficial lead placement resulted in skin perforation a few weeks after implantation.ConclusionThe implantation and explantation procedures are considered swift and easy to perform by both neurosurgeons and ENT surgeons. The implant is well tolerated by most participants. However, headache or pain around the implant can occur for up to 21 days post-operatively as anticipated with any such surgery. The expected benefits from the implant should always outweigh the potential disadvantages.

| S-EPMC10665563 | biostudies-literature

Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy.

Project description:(1) Background: Limited data exist on the safety and efficacy of epicardial left ventricular (LV) lead placement using video-assisted thoracoscopic surgery (VATS) for cardiac resynchronization therapy (CRT). (2) Methods: Acute and post-discharge outcomes of CRT were compared between patients with epicardial LV leads (Epicardial-LV group, n = 13) and those with endocardial LV leads (Endocardial-LV group, n = 243). (3) Results: Epicardial LV leads were implanted via VATS alone (n = 8) or along with mini-thoracotomy (n = 5), for failed endocardial implantation (n = 11) or recurrent lead dislodgement (n = 2). All epicardial procedures under general anesthesia with one-lung ventilation were successfully completed in 1.0 ± 0.4 h without phrenic nerve stimulation. LV pacing thresholds in the epicardial-LV (1.5 ± 1.0 V) and endocardial-LV (1.3 ± 0.8 V) were comparable (p = 0.651). All patients were discharged alive post-VATS 8.8 ± 3.9 days. During the follow-up (34.3 ± 28.6 months), all patients with epicardial LV leads stayed alive except for one cardiac death post-CRT 14 months and one heart transplantation post-CRT 30 months. All epicardial LV leads maintained stable performance without dislodgement/significant changes in pacing threshold/impedance. LV lead dislodgement occurred only in endocardial-LV (7/243, 2.9%). Efficacy in both groups was comparable in terms of QRS narrowing, increase in LV ejection fraction, and survival free of cardiac death, or heart-failure-related hospitalization. (4) Conclusions: Epicardial LV lead placement using VATS can be a safe and effective alternative to endocardial implantation, with comparable acute and post-discharge outcomes achieved by both approaches.

| S-EPMC9145737 | biostudies-literature

A Rare Case of Epicardial Lead Strangulation of Left Ventricular Inflow.

Project description:This is an unusual case of left atrioventricular groove strangulation by an abandoned epicardial pacing lead associated with mild left ventricular inflow obstruction, left atrial enlargement, and new atrial tachycardia that resolved with surgical lead removal. (Level of Difficulty: Intermediate.).

| S-EPMC8302054 | biostudies-literature

Minimally invasive direct left ventricular assist device implantation.

Project description: Not available

| S-EPMC10267810 | biostudies-literature

Acute Left Atrial Compression after Ventricular Assist Device Placement.

Project description: Not available

| S-EPMC9120857 | biostudies-literature