Implantation of the Automatic Implantable Cardioverter Defibrillator for Coronary Artery Disease - Surgical Experience in 185 Patients

Abstract

The results in 185 patients with coronary artery disease undergoing implantation of an automatic implantable cardioverter defibrillator (AICD) were reviewed with regard to the operative technique applied and problems observed. In 123 patients (group I) only AICD implantation was performed. Ninety patients were operated through sternotomy or thoracotomy while in 33 patients an endovenous/subcutaneous technique was used. Sixty-two patients (group II) underwent simultaneous coronary artery bypass grafting (CABG) and AICD implantation by median sternotomy. Perioperative mortality was 2.4% in group I with one fatality in the subgroup of endevenous/AICD placements and 11.3% in group II (p < 0.01). Overall infectious complications were low with 2 removals in group I and 1 in group II; however, no infections were observed after endovenous system implantation. It is concluded that the operative mortality rate of a combined approach is significantly higher, when compared to isolated AICD placement. However, the greater risk of the former cohort is mainly due to the impaired ventricular performance. Further investigations will have to prove whether a two-step approach using the endovenous technique in patients with a need for AICD and CABG will reduce the operative mortality.