Zusammenfassung
Thrombose beider Venae subclaviae können eine transvenöse Schrittmacher–Implantation unmöglich machen. Als letzte Möglichkeit bleibt dann oft nur noch die epimyokardiale Implantation via medianer Sternotomie, anterolateraler Thorakotomie oder über einen subxyphoidalen Zugang. Minimalinvasive Techniken, wie die Video–Assistierte–Thorakoskopie (VATS), sind etablierte thoraxchirurgische Verfahren und erlangen immer größere Bedeutung.
Wir beschreiben unsere ersten Erfahrungen mit der VATS–assistierten Zweikammer–Schrittmacher–Implantation bei 3 Patienten mit atrio–ventrikulärer Blockierung (AV-Block) und beidseitiger Thrombose der Venae subclaviae. Die VATS–Technik zur endokardialen Schrittmacher–Implantation besitzt das Potential chirurgisches Trauma, Komplikationsrisiko, postoperativer Schmerz sowie die postoperative Verweildauer deutlich zu reduzieren.
Summary
We describe our first experiences with a VATS–guided, transthoracic, double chamber pacemaker implantation in three cases with a third degree AV–block and bilateral subclavian venous thrombosis due to many years of hemodialysis. We used two small incisions performed in the seventh intercostal space at the posterior and the second in the third intercostal space at the anterior axillary line.
The VATS technique of endocardial pacemaker implantation has the potential to minimize surgical trauma, postoperative pain and to reduce the long postoperative rehabilitation associated with open pacemaker implantation especially in patients with subclavian venous thrombosis.
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Oster, O., Sirbu, H., Busch, T. et al. Erste operative Erfahrungen mit der videoskopischen Implantation von Herzschrittmachern: Eine innovative Technik. Z Herz-, Thorax-, Gefäßchir 18, 198–202 (2004). https://doi.org/10.1007/s00398-004-0455-z
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DOI: https://doi.org/10.1007/s00398-004-0455-z