Fearnot N E, Smith H J, Goode L B, Byrd C L, Wilkoff B L, Sellers T D
Hillenbrand Biomedical Engineering Center, Purdue University, West Lafayette, Indiana 47907.
Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):1864-70. doi: 10.1111/j.1540-8159.1990.tb06905.x.
Septicemia necessitates extraction of chronic pacemaker leads. Using locking stylets and sheaths to extract leads via the implantation vein (subclavian, cephalic, or jugular) and maneuvering devices, sheaths, and retrieval baskets via the femoral approach, extraction of 228 leads implanted 5 days to 240 months (mean 55 months) was attempted in 136 patients (mean 62 years) at 34 institutions. In addition to septicemia (9%) and infection (39%), total 48%, indications included prophylaxis/replacement (40%), and other (12%). Seventy-seven leads were atrial, 151 ventricular; 147 were unipolar, 81 bipolar; 96 had silicone insulation, 127 polyurethane, 1 poly/silicone, and 2 undetermined. Fixation included tines or fins (160), screw (40), flange (12), and other (16). One hundred and ninety-four leads were completely extracted, 19 partly extracted, and 15 not extracted. Procedural complications were: torn atrium requiring open heart repair (1), hemothorax requiring a chest tube and blood transfusions (1), subacute hemothorax requiring drainage 18 days after discharge (1), thrombosis treated by drugs (1), and myocardial avulsion without sequela (1). Important observations included the significant training required due to the large number of possible clinical variables, and the need to be prepared for life-threatening cardiovascular complications. With training, procedures done at higher volume and lower volume institutions met with similar success.
Intravascular lead extraction is a viable technique whose benefits outweigh the risks, given the proper intensive training and open heart surgical backup, and may obviate the need for open heart surgery for lead extraction.
败血症需要取出慢性起搏器导线。通过植入静脉（锁骨下静脉、头静脉或颈静脉）使用锁定探针和鞘管取出导线，并通过股动脉途径操作器械、鞘管和回收篮，在34家机构对136例患者（平均62岁）尝试取出植入5天至240个月（平均55个月）的228根导线。除败血症（9%）和感染（39%）外，总计48%，适应证包括预防/更换（40%）和其他（12%）。77根为心房导线，151根为心室导线；147根为单极导线，81根为双极导线；96根有硅胶绝缘层，127根有聚氨酯绝缘层，1根为聚/硅胶绝缘层，2根未确定。固定方式包括倒刺或鳍片（160根）、螺旋（40根）、凸缘（12根）和其他（16根）。194根导线完全取出，19根部分取出，15根未取出。手术并发症有：心房撕裂需要开胸修复（1例）、血胸需要放置胸管和输血（|例）、出院18天后需要引流的亚急性血胸（1例）、药物治疗的血栓形成（1例）和无后遗症的心肌撕裂（1例）。重要观察结果包括由于大量可能的临床变量需要大量培训，以及需要为危及生命的心血管并发症做好准备。经过培训，高容量和低容量机构进行的手术成功率相似。
血管内导线取出术是一种可行的技术，在进行适当的强化培训和有心脏直视手术备用的情况下，其益处大于风险，并且可能无需进行心脏直视手术来取出导线。
