Cooper Utilizes Robotics for Epicardial Lead Placement in Bi-ventricular Pacing

Bi-ventricular pacing, or cardiac resynchronization, has been established as a valuable treatment option for the nearly 30% of refractory heart failure patients who suffer from ventricular dysynchrony. Significant functional class improvement has been seen with this treatment in New York Heart Association (NYHA) class III and IV patients who have maximized medical therapy and have a confirmed ejection fraction of 35%.

Cardiac resynchronization requires placement of a third lead in the left ventricle to achieve bi-ventricular pacing. Lead placement is traditionally performed percutaneously via the coronary sinus. A technically challenging procedure complicated by wide variations in individual anatomy, electrophysiologists report a 15- 20% failure in left ventricular lead capture. In addition, clinicians have reported a nearly 10% rate of lead displacement resulting in late failure of lead capture.

“The success of bi-ventricular pacing in the treatment of heart failure is dependent on good lead placement and capture,” says Lawrence Gessman, M.D., director of Electrophysiology at the Cooper Heart Institute. “Unfortunately, we are dependent on the coronary venous anatomy, and in some patients it is nearly impossible to reach the wall of the left ventricle and establish good contact with the epicardium. In these patients, surgical implantation of epicardial leads is necessary,” adds Dr. Gessman.

Left figure: Illustratrates placement of pacing wires in bi-ventricular pacing. Right figure: Lack of coronary sinus branch necessitates epicardial placement of third lead via minimally invasive surgical procedure.

Cooper University Hospital is one of only a handful of centers nationwide that offer epicardial lead placement via a robotically assisted minimally invasive procedure, says Steven Marra, M.D., a Cooper cardiovascular-thoracic surgeon. “The procedure utilizes three small intercostal incisions, or ports, each one centimeter,” says Dr. Marra. “3-dimensional visualization is achieved via the da Vinci™ System, with one port used for the robotic camera and the other two for robotic tools,” he adds.

A left pericardiotomy is performed to select a targeted area on the lateral left ventricular wall for lead placement. “The procedure time is often only one hour and recovery is much easier than with standard surgical techniques presently available at other institutions,” reports Dr. Marra. “There is much less post-operative pain, with patients often able to go home the day of the procedure,” he adds. Excellent pacing and sensing function, as well as functional class improvement, has been reported in patient follow-up.

Epicardial lead placement is just one of the cardiovascular surgical procedures now being done at Cooper utilizing robotically assisted technology. “Soon we will be offering robotic atrial fibrillation ablation with this minimally invasive robotic technique,” says Dr. Marra, “further adding to the cutting-edge technology only available in this region at Cooper University Hospital’s Heart Institute.”

For more information about this procedure, robotic cardiovascular-thoracic surgery, or to refer a patient for consultation, please call: (856) 342-2141.