Department of Cardiology, University Hospital La Timone, Marseilles, France.
Heart Rhythm. 2011 Jul;8(7):1001-5. doi: 10.1016/j.hrthm.2011.02.007. Epub 2011 Feb 9.
Although risks and life-threatening complications associated with lead extraction are well characterized, practice patterns vary regarding whether procedures are performed in an operating room (OR) or electrophysiology (EP) laboratory with cardiothoracic surgical backup.
Our objective was to compare procedural outcomes and complications associated with lead extraction in the OR vs. EP laboratory.
Prospectively acquired data were pooled from 2 referral centers. Lead extraction procedures were performed between 2000 and 2010, encompassing a transition phase from the OR to EP laboratory. Analyses were conducted using generalized estimating equations.
A total of 1,364 leads (533 OR; 831 EP laboratory) were targeted in 684 consecutive procedures, 41.2% of which were in the OR. Laser sheaths and snares were used for 699 (51.2%) and 101 (7.4%) leads, respectively. Overall, 775 (93.1%) vs. 487 (91.4%) leads were completely extracted in the EP laboratory vs. OR [odds ratio 1.3, 95% confidence interval 0.9 to 2.1]. Complications occurred in 2.24% vs. 2.84%, respectively (P = .431). Two patients died because of superior vena caval lacerations (0.29%), 1 in each group. Rapid surgical intervention was helpful in 6 (0.9%) patients [4 OR (2 subclavian vein lacerations, 1 tricuspid valve laceration, 1 tamponade); 2 EP laboratory (tamponades)], with subsequently favorable outcomes. The only independent predictor of complications was older lead age [odds ratio 1.11 per year, 95% confidence interval 1.02 to 1.20].
Lead extraction in the EP laboratory with surgical backup is associated with a similarly low rate of complications and mortality as procedures performed in the OR.
虽然与铅提取相关的风险和危及生命的并发症已得到很好的描述，但关于程序是在手术室（OR）还是电生理（EP）实验室进行，是否需要心胸外科后备支持，实践模式存在差异。
我们的目的是比较 OR 与 EP 实验室中铅提取的程序结果和并发症。
从 2 个转诊中心前瞻性收集的数据进行汇总。铅提取程序于 2000 年至 2010 年进行，涵盖了从 OR 向 EP 实验室过渡的阶段。使用广义估计方程进行分析。
共针对 684 例连续手术中的 1364 个铅（533 个 OR；831 个 EP 实验室）进行了定位，其中 41.2%的铅在 OR 中。激光鞘和套索分别用于 699（51.2%）和 101（7.4%）个铅。总体而言，EP 实验室与 OR 相比，完全提取的铅分别为 775（93.1%）和 487（91.4%）[优势比 1.3，95%置信区间 0.9 至 2.1]。并发症发生率分别为 2.24%和 2.84%（P =.431）。由于上腔静脉撕裂，2 名患者死亡（0.29%），每组 1 名。6 名患者（4 名 OR [2 名锁骨下静脉撕裂，1 名三尖瓣撕裂，1 名填塞]；2 名 EP 实验室[填塞]）接受了快速手术干预，结果良好。并发症的唯一独立预测因素是铅龄较大[每年优势比 1.11，95%置信区间 1.02 至 1.20]。
在 EP 实验室进行铅提取，如有外科后备支持，其并发症发生率和死亡率与 OR 手术相似。
