Clinical application of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery

Abstract

Objective: To summarize the results and clinical application experience of one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. Methods: From November 2014 to July 2016, 15 patients (9 males and 6 females) with ages ranging from 50 to 73 (63.5±6.2) years requiring cardiac surgery with bradycardia underwent one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery. All operations were performed under general anesthesia with chest median incision approach. Among them, single chamber pacemaker (n=10) and dual chamber pacemaker (n=5) permanent epicardial pacing leads were implanted. Simultaneous procedures included valve replacement in 7 cases, valve replacement combined with atrial fibrillation ablation in 3 cases, coronary artery bypass grafting in 2 cases, aortic root replacement in 2 cases, and valve replacement combined with coronary artery bypass surgery in 1 case. Their parameters of pacemaker including sensitivity, pacing threshold, pacing impedance were measured during surgery and closely followed up at 1 week and 3, 6 months after surgery. Results: All 15 patients with epicardial permanent pacemaker implantation in the same period of cardiac surgery were successfully cured and discharged, without any surgical complications. A total of 20 epicardial electrodes were implanted for them including 5 right atrial electrodes and 15 right ventricular electrodes. The postoperative follow-up period ranged from 3 to 22 months. No electrode fracture and surgical wound infection occurred in those patients, and their impedance, sensing and stimulation thresholds were all in normal ranges during follow-up. Conclusions: For patients with bradycardia who required cardiac surgery, one-stage operation of epicardial permanent pacemaker implantation and cardiac surgery is safe and effective, and the results in the short-term and medium-term are satisfactory, avoiding the risk of staged surgery.