Subaxillary approach to cardiac electronic device implantation using a single surgical incision: a single-centre experience

• Published in: Interactive cardiovascular and thoracic surgery 2018-06, Vol.26 (6), p.912-918
• Main Authors: Bolzan, Bruna, Morosato, Martina, Caponi, Domenico, Tomasi, Luca, Silvestre, Giuseppe, Morani, Giovanni
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia, General; Arrhythmias, Cardiac - therapy; Axilla; Axillary Vein - surgery; Defibrillators, Implantable; Female; Hospitalization; Humans; Male; Middle Aged; Pectoralis Muscles; Prosthesis Implantation - methods; Surgical Wound; Young Adult
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivy002

Pacemakers and implantable cardioverter defibrillators have become more common in younger individuals, owing to broader indications and technological advances. Our goal was to report our long-term experience of implanting cardiac devices in young adults via a subaxillary approach with a hidden single incision, to minimize the aesthetic impact of the device. From 2003 to 2012, 23 patients underwent cardiac device implantation via a subaxillary approach while they were under general anaesthesia. The axillary vein was punctured under contrast-medium radiological guidance. The devices were positioned into the pocket under the pectoralis major muscle and over the fascia that envelopes the pectoralis minor muscle, through a lateral surgical access along the midaxillary line. Twenty-two single- and dual-chamber implantable cardioverter defibrillator and 1 dual-chamber pacemaker were implanted (mean age 32.2 ± 13.4 years). All procedures were successfully performed without complications; overall hospitalization after implantation was 3.3 days. During mean a follow-up of 65 ± 18 months, no deaths, infections or device migrations occurred. Two ventricular lead dislodgements requiring repositioning occurred within 1 month, and 1 defibrillation lead fracture occurred 5 years after implantation. All patients were extremely satisfied with the aesthetic result. A mild increase in the pacing threshold (0.88 ± 0.6 V at 0.4/0.5 ms at implantation vs 1.00 ± 0.3 V at 0.4/0.5 ms at 2-year follow-up, P = 0.063) and a statistically significant decrease in the pacing impedance (637 ± 161 ohm at implantation vs 499 ± 81 ohm at 2-year follow-up, P = 0.001) were observed, without any consequences. The subaxillary approach is a safe, feasible technique that requires a simple surgical procedure. The implantable cardioverter defibrillator functions properly at implantation and at long-term follow-up.