Minimally Invasive Surgical Alternatives for Left Ventricle Epicardial Lead Implantation in Heart Failure Patients José L. Navia, MD, Fernando A. Atik,

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Minimally Invasive Surgical Alternatives for Left Ventricle Epicardial Lead Implantation in Heart Failure Patients José L. Navia, MD, Fernando A. Atik, MD The Annals of Thoracic Surgery Volume 80, Issue 2, Pages 751-754 (August 2005) DOI: 10.1016/j.athoracsur.2004.03.020 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Minithoracotomy for left ventricular epicardial lead implantation, showing the incision site (upper left), patient position (upper right), and good exposure of the heart with a self-retaining retractor and lung deflation. The Annals of Thoracic Surgery 2005 80, 751-754DOI: (10.1016/j.athoracsur.2004.03.020) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Implantation of epicardial leads through a minithoracotomy, showing the use of a thoracoscopic manipulation tool (left) to place the leads in the posterolateral wall of the left ventricle (right). The Annals of Thoracic Surgery 2005 80, 751-754DOI: (10.1016/j.athoracsur.2004.03.020) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Port sites for video-assisted thoracoscopic surgery. The Annals of Thoracic Surgery 2005 80, 751-754DOI: (10.1016/j.athoracsur.2004.03.020) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Implantation of epicardial leads through video-assisted thoracoscopic surgery. The Annals of Thoracic Surgery 2005 80, 751-754DOI: (10.1016/j.athoracsur.2004.03.020) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Robotically assisted placement of epicardial leads with the arms in place through the ports. The Annals of Thoracic Surgery 2005 80, 751-754DOI: (10.1016/j.athoracsur.2004.03.020) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Robotically assisted placement, showing the tunneling of the leads as far anteriorly as possible after implantation. The Annals of Thoracic Surgery 2005 80, 751-754DOI: (10.1016/j.athoracsur.2004.03.020) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions