Bilateral Thoracoscopic Sympathectomy After Sternotomy for Left Ventricular Assist Device Insertion

Our case is a 73-year-old male patient with persistent ventricular tachycardia leading to recent syncopal episodes despite ventricular tachycardia ablation and multiple stellate ganglion blocks, frequent hospital admissions, and acute on chronic congestive heart failure requiring an intraaortic balloon pump. The decision was made to proceed with left ventricular assist device placement and bilateral sympathectomies simultaneously. After performing the sternotomy and widely opening bilateral pleural spaces, the lower third of the stellate ganglia to the level of T4 was removed using a combination of the thoracoscope with the sternotomy incision. The use of thoracoscopy greatly assisted with visualization during the sympathectomy. (c) 2022 by The Society of Thoracic Surgeons

Automated summary

The case describes a 73-year-old male patient with persistent ventricular tachycardia leading to recent syncopal episodes, requiring left ventricular assist device placement and bilateral sympathectomies. The use of thoracoscopy greatly assisted with visualization during the sympathectomy procedure.