Department of Surgery, Columbia University Medical Center, New York, New York 10032, USA.
Ann Thorac Surg. 2010 Jan;89(1):44-50. doi: 10.1016/j.athoracsur.2009.10.025.
The value of extraction of infected or hazardous epicardial and endocardial pacemaker and internal cardioverter defibrillator (ICD) leads is well established. Recent reviews including all leads and patches are lacking. This review describes experience with open and percutaneous techniques, including all lead types and indications.
With Institutional Review Board approval, we reviewed charts of all adults and children undergoing extraction of permanent pacemaker and ICD leads and patches by a single operator between 1993 and 2008.
Overall, 145 leads and 7 patches were removed from 79 patients. Dwell time averaged 56.2 months. The commonest indications for extraction were infection (73.4%) or risk of lead fracture (20.3%). Most leads (84.2%) were extracted percutaneously. Removal was complete for 131 leads (86.2%) and partial in 14. Incomplete lead removal was rarely associated with clinical complications. Minor complications occurred in 6 patients (7.6%) and major complications occurred in 3 (3.8%). The major complication rate was 16.7% for the open group and 1.5% in the percutaneous group.
Pacemaker and ICD infections generally respond to antibiotics, complete hardware removal, and a hardware free interval. However, these principles cannot always be invoked, and the risk of complications is likely to increase when hardware cannot be completely removed or when a hardware-free interval is unsafe or inadvisable. Percutaneous lead extraction is superior to open extraction in terms of safety and comfort, but epicardial extraction techniques remain critically important in selected patients.
从感染或有危险的心外膜和心内膜起搏器和植入式心律转复除颤器（ICD）导线中提取的价值已得到充分证实。最近的综述包括所有的导线和补丁都缺乏。这篇综述描述了开放和经皮技术的经验，包括所有类型的导线和适应证。
经机构审查委员会批准，我们回顾了 1993 年至 2008 年间，一位医生为 79 例成人和儿童进行的所有永久性起搏器和 ICD 导线和补丁的提取手术记录。
总体而言，从 79 例患者中取出了 145 根导线和 7 个补丁。留置时间平均为 56.2 个月。最常见的提取适应证是感染（73.4%）或导线断裂风险（20.3%）。大多数导线（84.2%）经皮取出。131 根导线（86.2%）完全取出，14 根部分取出。不完全导线取出很少与临床并发症有关。6 例患者（7.6%）发生轻微并发症，3 例患者（3.8%）发生严重并发症。开放组的严重并发症发生率为 16.7%，经皮组为 1.5%。
起搏器和 ICD 感染一般对抗生素、完全硬件去除和无硬件间隔期有反应。然而，这些原则并非总是可行的，当无法完全去除硬件或无硬件间隔期不安全或不建议时，并发症的风险可能会增加。经皮导线提取在安全性和舒适度方面优于开放性提取，但在某些患者中，心外膜提取技术仍然至关重要。
