经食管超声心动图定义的 100 例心内膜赘生物患者的经皮起搏器和植入式心脏复律除颤器导线拔除术。

Percutaneous pacemaker and implantable cardioverter-defibrillator lead extraction in 100 patients with intracardiac vegetations defined by transesophageal echocardiogram.

机构信息

Division of Cardiovascular Diseases, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA.

出版信息

J Am Coll Cardiol. 2010 Mar 2;55(9):886-94. doi: 10.1016/j.jacc.2009.11.034.

DOI:10.1016/j.jacc.2009.11.034

PMID:20185039

Abstract

OBJECTIVES

We describe the feasibility, safety, and clinical outcomes of percutaneous lead extraction in patients at a tertiary care center who had intracardiac vegetations identified by transesophageal echocardiogram.

BACKGROUND

Infection in the presence of intracardiac devices is a problem of considerable morbidity and mortality. Patients with intracardiac vegetations are at high risk for complications related to extraction and protracted clinical courses. Historically, lead extraction in this cohort has been managed by surgical thoracotomy.

METHODS

We analyzed percutaneous lead extractions performed from January 1991 to September 2007 in infected patients with echocardiographic evidence of intracardiac vegetations, followed by a descriptive and statistical analysis.

RESULTS

A total of 984 patients underwent extraction of 1,838 leads; local or systemic infection occurred in 480 patients. One hundred patients had intracardiac vegetations identified by transesophageal echocardiogram, and all underwent percutaneous lead extraction (215 leads). Mean age was 67 years. Median extraction time was 3 min per lead; median implant duration was 34 months. During the index hospitalization, a new device was implanted in 54 patients at a median of 7 days after extraction. Post-operative 30-day mortality was 10%; no deaths were related directly to the extraction procedure.

CONCLUSIONS

Patients with intracardiac vegetations identified on transesophageal echocardiogram can safely undergo complete device extraction using standard percutaneous lead extraction techniques. Permanent devices can safely be reimplanted provided blood cultures remain sterile. The presence of intracardiac vegetations identifies a subset of patients at increased risk for complications and early mortality from systemic infection despite device extraction and appropriate antimicrobial therapy.

摘要

目的

我们描述了在经食管超声心动图（TEE）发现心内赘生物的三级医疗中心患者中行经皮导线拔除术的可行性、安全性和临床结果。

背景

心内器械感染是一个发病率和死亡率都很高的问题。有心内赘生物的患者因与拔除相关的并发症和延长的临床病程而处于高风险之中。在历史上，这一队列中的导线拔除术一直由开胸手术来管理。

方法

我们分析了 1991 年 1 月至 2007 年 9 月期间因 TEE 显示心内赘生物而接受感染患者行经皮导线拔除术，并进行了描述性和统计学分析。

结果

共有 984 例患者接受了 1838 根导线的拔除术；480 例患者发生局部或全身感染。100 例患者经 TEE 发现有心内赘生物，均行经皮导线拔除术（215 根导线）。平均年龄为 67 岁。每根导线的平均拔除时间为 3 分钟；中位植入时间为 34 个月。在索引住院期间，54 例患者在拔除后 7 天中位数时植入新的器械。术后 30 天死亡率为 10%；没有死亡与拔除术直接相关。