PMC9646397_01
(
A
) Three weeks after the implantation. (
B
) The complete system was removed, and a large tissue gap remained. (
C
) Negative pressure of 125 mm Hg was applied, to cover the tissue defect and facilitate tissue regrowth. (
D
) Three weeks after the device explantation. With continuous negative pressure wound therapy, the absence of skin tissue was almost completely closed.
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The complete system was explanted, and we utilized negative pressure wound therapy for the treatment of the remaining tissue ( Fig. 1 ). 
Surgical cardiac resynchronization therapy device with defibrillator (CRT-D) implantation. (
A
) Right lateral minithoracotomy. The right ventricular and right atrial leads are positioned and fixed with purse-string sutures. (
B
) Left lateral minithoracotomy. The left ventricular lead was introduced through the apex of the left ventricle. (
C
) The leads were pulled through tunnels into the abdominal part and attached to the CRT-D device. (
D
) Positioning of the leads was performed with fluoroscopy guidance. (
E
) Good parameters were recorded at the end of the procedure. (
F
) Six months after the surgery.
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Bleeding was controlled and the electrodes were secured with purse-string sutures around the puncture points ( Fig. 2A ).  Fig. 2B ). Fluoroscopy was utilized for the endocardial fixation of the electrode at the lateral wall of the LV ( Fig. 2D ).   The device was implanted in the abdominal area, where the skin was almost intact, below the diaphragm and the electrodes were tunneled ( Fig. 2C ) ( Video 1 ).