Abdominal cardiac devices in pediatric and congenital heart disease: a practice model transition.

Abstract

Abdominal cardiac implantable electronic device maintenance procedures are traditionally performed by cardiac surgeons. The University of Michigan Congenital Heart Center transitioned from this practice model to one in which electrophysiologists perform the majority of these procedures. This study presents the outcomes of these procedures during this transition. Retrospective cohort study of all patients undergoing abdominal device maintenance procedure, inclusive of generator change, removal, or placement with preexisting leads from January 2005 to July 2013. Procedures involving epicardial lead placement were excluded. The primary outcome was major complications defined as any intraoperative complication, the requirement of an additional operative intervention, or hospitalization for device-related infection. There were 113 procedures on 93 patients. Of these, 84 (74%) procedures were on patients with congenital heart disease. Cardiac surgeons performed 54 (48%) procedures and electrophysiologists performed 59 (52%). Mean age was 16 ± 11 years. The groups were similar regarding age and proportion with congenital heart disease (CHD). Major complications occurred in 3 (5.5%) cardiac surgeon procedures and 2 (3.4%) electrophysiologist procedures. There is no difference in the risk of major complications between groups (P = .59). This 8.5-year period encompassed a practice model transition from cardiac surgeon-performed abdominal device procedures to primarily electrophysiologist-performed abdominal device procedures. There was no difference in the risk of complications between services. This suggests that electrophysiologist-performed abdominal cardiac device maintenance procedures are a viable practice model, provided there is support and collaboration from the cardiac surgery service.