CLINICAL-EXPERIENCE WITH NONTHORACOTOMY CARDIOVERTER-DEFIBRILLATORS

A new generation of defibrillators has been introduced that do not req uire a thoracotomy. The purpose of this report was to examine 100 cons ecutive nonthoracotomy implantations at our institution and compare th em with a series of 102 patients undergoing thoracotomy implantations by the same surgeon over a 4-year period between August 1989 and Septe mber 1994. The two groups were comparable for age, sex, comorbidity, c ardiac disease status, ejection fraction, and electrophysiologic prese ntation. Nonthoracotomy systems were implanted successfully in 94% of patients. Patients undergoing a nonthoracotomy implantation had signif icantly shorter intensive care unit (1.7 +/- 1.7 versus 3.3 +/- 3.9 da ys; p < 0.005) and postoperative stays (5.0 +/- 2.8 versus 9.5 +/- 5.6 days; p < 0.001) than patients undergoing a thoracotomy approach. Thi s was due to a significant decrease in the incidence of postoperative complications from 29% in the thoracotomy group to 11% in the nonthora cotomy group (p < 0.001). There was no significant difference in overa ll mortality rates. Nonthoracotomy systems are implantable in the majo rity of patients and are associated with less morbidity and shorter ho spital stays than traditional thoracotomy approaches.