Pediatric Cardiology and Cardiac Surgery
Vol.27 No.2 2011 (98-104)

Yoshimichi Kosaka, Toshihide Asou, Yuko Takeda, Hirokuni Ono

Department of Cardiovascular Surgery, Kanagawa Children’s Medical Center, Yokohama, Japan


Background: In order to avoid several problems associated with epicardial leads in neonates, infants and younger children, we applied the trans-thoracic approach with creation of a pacemaker pocket in the axillary region (axillary approach).
Purpose: The aim of this study was to evaluate the adequacy of the present approach based on midterm results.
Methods: Seventeen patients who underwent pacemaker implantation using the axillary approach at our institution were investigated. All patients were less than 6 years of age at the time of surgery. Post-operative complications, lead characteristics and freedom from lead failure were retrospectively investigated. The results were compared with those of 20 patients who previously underwent pacemaker implantation using the subxiphoid approach with the creation of a pacemaker pocket beneath the rectus muscle of the abdomen (subxiphoid approach) at our institution.
Results: The median age and body weight at the time of surgery were 9 months (4 days to 6 years) and 7.1 kg (2.6 to 17 kg), respectively. Eight patients had previously undergone sternotomy. In three patients, pacemaker systems were re-implanted using the present approach because of complications involving the epicardial leads previously implanted using other techniques. Twenty-four pacing leads (13 atrial, 11 ventricular) were implanted using the axillary approach. Mean follow-up duration was 35±24 months (mean±SD, longest: 76 months). No post-operative complications were noted except bacterial infection of the generator pocket three months after implantation in one patient. Elevation of the pacing threshold occurred in only one case. The 5-year freedom from lead failure rate was 94% and was superior to that of the subxiphoid approach (72%).
Conclusion: Midterm results of the axillary approach are satisfactory. We conclude that the axillary approach is potentially useful for pacemaker implantation in neonates, infants and younger children.