Background:

The use of a lateral mini-thoracotomy presents several advantages over the standard access, such as less surgical trauma, reduced morbidity and mortality, shorter recovery time and better cosmetic results, but presents difficulties if temporary pacing is required.

Objective:

The aim of this study was to evaluate the therapeutic use of a Swan-Ganz catheter with pacing capabilities and analyze its complications.

Methods:

Patients undergoing scheduled minimally invasive mitral valve surgery through lateral mini-thoracotomy were included in the study. Therapeutic use of the pacing catheter was defined as the need for pacing due to bradyarrhythmias or conduction disorders or need of increasing heart rate in case of hemodynamic instability. Patients undergoing urgent or emergency surgery were excluded from the study.

Results:

A total of 517 patients were included in the study; mean age was 68.3 ± 10.4 years and 289 (55.9%) were men; 115 patients (22.2%) underwent mitral valve replacement and 402 (77.7%) mitral valve repair. The following concomitant procedures were carried out: 294 (56.9%) Maze procedures, 182 (35.2%) left atrial appendage closures, 9 (1.7%) atrial septal defect closures and 14 (2.7%) tricuspid valve repair surgeries. In the postoperative period 162 (31.3%) patients required pacing due to bradyarrhythmias in 85 cases (52.47%), conduction disorders in 50 (30.86%), and need to increase heart rate in 27 (16.66%) patients with low cardiac output syndrome. Postoperative mortality was 2.32% (n=12). Fourteen (2.7%) patients presented loss of capture that was resolved with catheter repositioning, while 2 (0.6%) patients presented catheter entrapment requiring reintervention.

Conclusion:

Almost one-third of the patients undergoing lateral mini-thoracotomy required therapeutic use of the pacing Swan-Ganz catheter. Two patients presented catheter entrapment and required surgical reintervention.

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