Marijon Eloi, Boveda Serge, De Guillebon Maxime, Jacob Sophie, Vahdat Olivier, Barandon Laurent, Combes Nicolas, Sidobre Laurent, Albenque Jean-Paul, Clémenty Jacques, Bordachar Pierre
Département de Rythmologie, Clinique Pasteur, Toulouse, France.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S38-41. doi: 10.1111/j.1540-8159.2008.02225.x.
We measured the proportion of intravascular leads, which can be extracted by simple traction versus with newer techniques, and examined the overall safety and success rate of lead extractions.
Between January 2005 and December 2007, 311 consecutive patients (mean age = 70 +/- 14 years, 79% men) underwent extractions of 250 atrial, 318 ventricular, and 22 coronary sinus leads, in the surgical facilities of two experienced medical centers, under general anesthesia, at a mean of 7.2 +/- 5.1 years (range 0.1-27.0) after lead implantation. Infection was the indication for extraction in 67.5% of cases. Complementary techniques were used when simple extraction with a locking stylet was unsuccessful.
Simple traction, with or without a locking stylet, allowed the complete removal in 27.0% (95% confidence interval [CI] 22.1-31.9) of patients. A mechanical sheath, laser sheath, and/or lasso catheter were used in the remaining patients. The overall extraction success rate was 89.7% (95% CI 86.3-93.1). There was one procedure-related death (0.3%; 95% CI 0.0-1.0). Among five other deaths occurring within 10 days after the procedure, four were due to septic shock. Duration of lead implantation was the strongest independent predictor of major adverse events (P = 0.002) and incomplete lead extraction (P = 0.005).
In contrast with simple traction, advanced techniques allowed the complete extraction of nearly 90% of leads. In experienced hands and with surgical back-up, these techniques were safe. Patients presenting with infected implanted cardiac devices suffered a high rate of major adverse despite complete extraction of the lead(s).
我们测量了可通过简单牵引与采用更新技术取出的血管内导联的比例，并检查了导联取出的总体安全性和成功率。
在2005年1月至2007年12月期间，311例连续患者（平均年龄 = 70±14岁，79%为男性）在两个经验丰富的医疗中心的手术设施中，于导联植入后平均7.2±5.1年（范围0.1 - 27.0年）接受全身麻醉下的250根心房导联、318根心室导联和22根冠状窦导联的取出。67.5%的病例中感染是取出的指征。当使用锁定管心针进行简单取出未成功时，采用了辅助技术。
无论有无锁定管心针，简单牵引使27.0%（95%置信区间[CI] 22.1 - 31.9）的患者完全取出。其余患者使用了机械鞘、激光鞘和/或套索导管。总体取出成功率为89.7%（95% CI 86.3 - 93.1）。有1例与手术相关的死亡（0.3%；95% CI 0.0 - 1.0）。在手术后10天内发生的另外5例死亡中，4例是由于感染性休克。导联植入时间是主要不良事件（P = 0.002）和导联不完全取出（P = 0.005）的最强独立预测因素。
与简单牵引相比，先进技术使近90%的导联得以完全取出。在经验丰富的人员操作并具备手术支持的情况下，这些技术是安全的。尽管导联已完全取出，但植入心脏装置感染的患者仍有较高的主要不良事件发生率。
