SUBXIPHOID APPROACH FOR INSERTION OF ICDS AFTER PREVIOUS MEDIAN STERNOTOMY

To avoid the risks both of repeat median sternotomy and of thoracotomy , the modified subxiphoid approach was adopted for insertion of implan table cardioverter-defibrillators in 10 patients who had previously un dergone cardiac operations via median sternotomy. Effective implantabl e cardioverter-defibrillator systems were implanted in all patients. T here were no operative deaths and no hemorrhagic or respiratory compli cations. One patient underwent repositioning of a dislodged superior v ena caval electrode, and an infected generator pocket developed in 1 p atient. Early extubation was routine. Two patients were observed in th e coronary care unit for the first postoperative night. Postoperative pain was controlled with oral analgesic agents. The subxiphoid approac h is safe and effective, and it carries a substantially lower risk of complications than other techniques, even in this high-risk group of p atients. By minimizing the need for admission to the intensive care un it, invasive monitoring, and prolonged ventilatory support, by reducin g surgical complications, and by shortening the hospital stay, the sub xiphoid approach saved an average of $3,295 per patient.