Fixation of a Myocardial Lead via a 5th Costal Cartilage Resection Approach

(Department of Surgery I, Tokyo Women's Medical University, Tokyo, Japan)

Takashi Adachi Masayoshi Yokoyama Kunihiro Oyama
Toyohide Ikeda Takako Matsumoto Takamasa Onuki
Median sternotomy is commonly used for suture fixation of a myocardial lead. Instead of this conventional technique, we used the technique of resecting the 5th costal cartilage through a small horizontal skin incision at the left 5th sternocostal junction in 33 patients, between 1980 and 2001. Here we describe this procedure, as well as the outcome of patients who underwent this myocardial lead fixation procedure. A skin incision of about 6 to 8 cm was made in the left 5th intercostal space. Approximately 5 cm of the 5th costal cartilage was resected through the skin incision. Then, a myocardial lead was sutured on to the anterior wall of the right ventricle. The generator was generally placed in the upper subcutaneous space of abdomen. Additional costal cartilages were removed in 7 patients in whom a larger operating field could not be obtained initially. The electrode was sutured to the right ventricular wall in 28 patients, right atrial wall in 6 patients, and the left ventricular wall in 5 patients. The mean operation time was 150 min and mean bleeding during operation was 82 ml. Long-term results (258 months at the longest, at the time of writing) showed that all the patients did well, except for one adult who suffered cerebral infarction, and one child with pacing failure. Based on these findings, we believe that this procedure is minimally invasive method, and is good for fixation of a myocardial lead.
@Jpn. J. Cardiovasc. Surg. 32F6-8i2003j