CHSU Discovery

Abstract

Postoperative ventricular arrhythmias (POVAs) after cardiac surgery are associated with significant mortality and morbidity. Established risk factors include advanced age, low ejection fractions (EF), and prior arrhythmic events. POVA is challenging to treat and correlates with worse clinical outcomes. Thoracic sympathectomy is a widely accepted, but underutilized, treatment option for refractory ventricular arrhythmias, decreasing arrhythmic activity and implantable cardioverter-defibrillators (ICD) shocks. To mitigate POVA in high risk patients, we propose a two stage treatment strategy: bilateral thoracic sympathectomy prior to intended cardiac procedure. Here, we present the first reported successful case of a patient with an EF of 25-30% with resistant ventricular arrhythmias, coronary artery disease (CAD), and aortic insufficiency (AI) who was treated with the two-staged approach of bilateral T1-T4 thoracoscopic sympathectomy and partial stellate ganglionectomy followed by coronary artery bypass graft (CABG), aortic valve replacement (AVR), left atrial appendage closure, and temporary left ventricular assist device.