THORACOSCOPIC PLACEMENT OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PATCH LEADS IN SHEEP

Background. A thoracoscopic technique was developed for the placement of commercially available implantable cardioverter-defibrillator (ICD) patch leads in sheep. Methods and Results. Small ICD patch leads (13. 5 cm2, A-67) were placed thoracoscopically in sheep (n=5) that had sur vived coronary artery ligation from a previous experiment. The techniq ue used three small incisions in the left chest. After lysis of adhesi ons, the ICD patch lead was introduced through a mediastinoscope. The ICD patch lead was secured in the extrapericardial position with surgi cal clips placed in the four corners of the ICD patch lead. After 2 we eks, a median sternotomy was performed, and ICD patch leads were reexa mined for positioning. Extensive fibrosis was noted to adhere the ICD patch lead to the pericardium. The surgical clips were found intact in all animals without noticeable migration of patch lead position. Ther e was no mortality related to ICD patch lead placement, and estimated blood loss was less than 30 mL without use of cautery. Conclusions. Co mmercially available ICD patch leads may be reliably and safely placed with minimal patch migration in sheep using thoracoscopic techniques.