Henrikson Charles A, Zhang Karl, Brinker Jeffrey A
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland 21205, USA.
Pacing Clin Electrophysiol. 2011 Jan;34(1):32-6. doi: 10.1111/j.1540-8159.2010.02941.x. Epub 2010 Oct 29.
Transvenous lead extraction patients tend to have multiple medical problems complicated by prolonged infections that may result in high-mortality rates following a successful procedure.
All adult patients referred for lead extraction for infection over a 4-year period were included in this study. Mortality following the procedure was assessed using hospital records and the Social Security Death Index.
Indications for extraction were systemic infection (n = 34) and isolated pocket infection (n = 33). Of the 67 patients, 47 (70%) were still alive at follow-up (6-55 months). No patient died during or within 24 hours of the procedure, and two were sent to emergent surgery and did well. However, five died during prolonged hospitalizations, and two were discharged to hospice care and died shortly thereafter. The remaining 13 deaths occurred after discharge from the hospital at a mean interval of 15 months (range, 24 days to 35 months) following the procedure. Notably, six of seven patients who died in the hospital, and nine of 13 who died after discharge, had bacteremia as their indication for extraction, for an overall mortality risk of 44% in patients with systemic infection.
True risk assessment for lead extraction patients is underestimated and may be related to the focus on the procedural risks, while the underlying illness and physiologic state may account for the excess mortality following a successful extraction. In most cases, the infected hardware contributed to the length and severity of the illness, and thus earlier consideration for extraction may be warranted.
经静脉导线拔除患者往往存在多种医疗问题，并伴有长期感染，这可能导致手术成功后死亡率较高。
本研究纳入了在4年期间因感染而转诊进行导线拔除的所有成年患者。使用医院记录和社会保障死亡指数评估术后死亡率。
拔除指征为全身感染（n = 34）和孤立的囊袋感染（n = 33）。67例患者中，47例（70%）在随访（6 - 55个月）时仍存活。手术期间或术后24小时内无患者死亡，2例接受急诊手术且情况良好。然而，5例在长期住院期间死亡，2例出院后接受临终关怀并随后死亡。其余13例死亡发生在出院后，术后平均间隔15个月（范围，24天至35个月）。值得注意的是，7例住院死亡患者中有6例，13例出院后死亡患者中有9例，其拔除指征为菌血症，全身感染患者的总体死亡风险为44%。
导线拔除患者的真正风险评估被低估，可能与关注手术风险有关，而潜在疾病和生理状态可能是成功拔除后死亡率过高的原因。在大多数情况下，感染的硬件导致了疾病的持续时间和严重程度，因此可能有必要更早考虑拔除。
