Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients
Background The current indications of cardiac implantable electronic devices (CIEDs) have expanded to include young patients with serious cardiac risk factors, but CIED placement has the disadvantage of involving unsightly scarring and bulging of the chest wall. A collaborative team of cardiologist...
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2017-01-01
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| Series: | Archives of Plastic Surgery |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2017.44.1.34 |
| _version_ | 1811303560455913472 |
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| author | Joo Hyun Oh Chae Min Kim Seung Yong Song Jae Sun Uhm Dae Hyun Lew Dong Won Lee |
| author_facet | Joo Hyun Oh Chae Min Kim Seung Yong Song Jae Sun Uhm Dae Hyun Lew Dong Won Lee |
| author_sort | Joo Hyun Oh |
| collection | DOAJ |
| description | Background The current indications of cardiac implantable electronic devices (CIEDs) have expanded to include young patients with serious cardiac risk factors, but CIED placement has the disadvantage of involving unsightly scarring and bulging of the chest wall. A collaborative team of cardiologists and plastic surgeons developed a technique for the subpectoral placement of CIEDs in young female patients via a transaxillary approach.
Methods From July 2012 to December 2015, subpectoral CIED placement via an axillary incision was performed in 10 young female patients, with a mean age of 25.9 years and mean body mass index of 20.1 kg/m2. In the supine position, with the patient's shoulder abducted, an approximately 5-cm linear incision was made along one of the deepest axillary creases. The submuscular plane was identified at the lateral border of the pectoralis major, and the dissection continued over the clavipectoral fascia until the subpectoral pocket could securely receive a pulse generator. Slight upward dissection also exposed an entrance to the subclavian vein, allowing the cardiology team to gain access to the vein. One patient with dilated cardiomyopathy underwent augmentation mammoplasty and CIED insertion simultaneously.
Results One case of late-onset device infection occurred. All patients were highly satisfied with the results and reported that they would recommend the procedure to others.
Conclusions With superior aesthetic outcomes compared to conventional methods, the subpectoral placement of CIEDs via a transaxillary approach is an effective, single-incision method to hide operative scarring and minimize bulging of the device, and is particularly beneficial for young female or lean patients. |
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| id | doaj.art-538499a69eff4460a889d59576570110 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-13T07:50:17Z |
| publishDate | 2017-01-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-538499a69eff4460a889d595765701102022-12-22T02:55:34ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712017-01-014401344110.5999/aps.2017.44.1.34801Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female PatientsJoo Hyun Oh0Chae Min Kim1Seung Yong Song2Jae Sun Uhm3Dae Hyun Lew4Dong Won Lee5Department of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, KoreaDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, KoreaDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, KoreaDepartment of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, KoreaDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, KoreaDepartment of Plastic and Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, KoreaBackground The current indications of cardiac implantable electronic devices (CIEDs) have expanded to include young patients with serious cardiac risk factors, but CIED placement has the disadvantage of involving unsightly scarring and bulging of the chest wall. A collaborative team of cardiologists and plastic surgeons developed a technique for the subpectoral placement of CIEDs in young female patients via a transaxillary approach. Methods From July 2012 to December 2015, subpectoral CIED placement via an axillary incision was performed in 10 young female patients, with a mean age of 25.9 years and mean body mass index of 20.1 kg/m2. In the supine position, with the patient's shoulder abducted, an approximately 5-cm linear incision was made along one of the deepest axillary creases. The submuscular plane was identified at the lateral border of the pectoralis major, and the dissection continued over the clavipectoral fascia until the subpectoral pocket could securely receive a pulse generator. Slight upward dissection also exposed an entrance to the subclavian vein, allowing the cardiology team to gain access to the vein. One patient with dilated cardiomyopathy underwent augmentation mammoplasty and CIED insertion simultaneously. Results One case of late-onset device infection occurred. All patients were highly satisfied with the results and reported that they would recommend the procedure to others. Conclusions With superior aesthetic outcomes compared to conventional methods, the subpectoral placement of CIEDs via a transaxillary approach is an effective, single-incision method to hide operative scarring and minimize bulging of the device, and is particularly beneficial for young female or lean patients.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2017.44.1.34defibrillators, implantablepacemaker, artificialcardiac resynchronization therapy |
| spellingShingle | Joo Hyun Oh Chae Min Kim Seung Yong Song Jae Sun Uhm Dae Hyun Lew Dong Won Lee Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients Archives of Plastic Surgery defibrillators, implantable pacemaker, artificial cardiac resynchronization therapy |
| title | Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients |
| title_full | Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients |
| title_fullStr | Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients |
| title_full_unstemmed | Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients |
| title_short | Transaxillary Subpectoral Placement of Cardiac Implantable Electronic Devices in Young Female Patients |
| title_sort | transaxillary subpectoral placement of cardiac implantable electronic devices in young female patients |
| topic | defibrillators, implantable pacemaker, artificial cardiac resynchronization therapy |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2017.44.1.34 |
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