Automatic Implantable Cardioverter Defibrillator Implantation after Previous Open Heart Surgery: Subcostal Incision and Small Left Anterior Thoracotomy

In order to avoid the risk of major bleeding with redo sternotomy, an alternative surgical approach for the implantation of an automatic implantable cardioverter defibrillation (AICD) is presented. A subcostal incision in combination with a small left anterior thoracotomy was used in three patients. The procedure was easy to perform, considerably shorter than a redo sternotomy and well tolerated by the patient. We recommend this approach for AICD implantation in cases with previous heart operation.