Implante de marca-passo epicárdico por acesso minimamente invasivo em neonatos com bloqueio atrioventricular congênito

Translated title of the contribution: Minimally invasive epicardial pacemaker implantation in neonates with congenital heart block

Roberto Costa, Katia Regina da Silva, Martino Martinelli Filho, Roger Carrillo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). Objective: This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. Methods: Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0%) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3%) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. Results: All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. Conclusion: Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.

Original languagePortuguese
Pages (from-to)331-339
Number of pages9
JournalArquivos Brasileiros de Cardiologia
Volume109
Issue number4
DOIs
StatePublished - Oct 1 2017

Fingerprint

Atrioventricular Block
Newborn Infant
Congenital Heart Defects
Heart Failure
Steroids
Hemorrhage
Congenital heart block
Lead

Keywords

  • Atrioventricular block
  • Heart defects, congenital
  • Infants newborns
  • Pacemaker, artificial

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Implante de marca-passo epicárdico por acesso minimamente invasivo em neonatos com bloqueio atrioventricular congênito. / Costa, Roberto; da Silva, Katia Regina; Martinelli Filho, Martino; Carrillo, Roger.

In: Arquivos Brasileiros de Cardiologia, Vol. 109, No. 4, 01.10.2017, p. 331-339.

Research output: Contribution to journalArticle

Costa, Roberto ; da Silva, Katia Regina ; Martinelli Filho, Martino ; Carrillo, Roger. / Implante de marca-passo epicárdico por acesso minimamente invasivo em neonatos com bloqueio atrioventricular congênito. In: Arquivos Brasileiros de Cardiologia. 2017 ; Vol. 109, No. 4. pp. 331-339.
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abstract = "Background: Few studies have characterized the surgical outcomes following epicardial pacemaker implantation in neonates with congenital complete atrioventricular block (CCAVB). Objective: This study sought to assess the long-term outcomes of a minimally invasive epicardial approach using a subxiphoid access for pacemaker implantation in neonates. Methods: Between July 2002 and February 2015, 16 consecutive neonates underwent epicardial pacemaker implantation due to CCAVB. Among these, 12 (75.0{\%}) had congenital heart defects associated with CCAVB. The patients had a mean age of 4.7 ± 5.3 days and nine (56.3{\%}) were female. Bipolar steroid-eluting epicardial leads were implanted in all patients through a minimally invasive subxiphoid approach and fixed on the diaphragmatic ventricular surface. The pulse generator was placed in an epigastric submuscular position. Results: All procedures were successful, with no perioperative complications or early deaths. Mean operating time was 90.2 ± 16.8 minutes. None of the patients displayed pacing or sensing dysfunction, and all parameters remained stable throughout the follow-up period of 4.1 ± 3.9 years. Three children underwent pulse generator replacement due to normal battery depletion at 4.0, 7.2, and 9.0 years of age without the need of ventricular lead replacement. There were two deaths at 12 and 325 days after pacemaker implantation due to bleeding from thrombolytic use and progressive refractory heart failure, respectively. Conclusion: Epicardial pacemaker implantation through a subxiphoid approach in neonates with CCAVB is technically feasible and associated with excellent surgical outcomes and pacing lead longevity.",
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