Miller Amy L, Kramer Daniel B, Lewis Eldrin F, Koplan Bruce, Epstein Laurence M, Tedrow Usha
Department of Medicine, Cardiovascular Division, Brigham & Women's Hospital, Boston, Massachusetts, USA.
Pacing Clin Electrophysiol. 2011 Apr;34(4):490-500. doi: 10.1111/j.1540-8159.2010.03014.x.
While surgical epicardial lead placement is performed in a subset of cardiac resynchronization therapy patients, data comparing survival following surgical versus transvenous lead placement are limited. We hypothesized that surgical procedures would be associated with increased mortality risk.
Long-term event-free survival was assessed for 480 consecutive patients undergoing surgical (48) or percutaneous (432) left ventricle (LV) lead placement at our institution from January 2000 to September 2008.
Baseline clinical and demographic characteristics were similar between groups. While there was no statistically significant difference in overall event-free survival (P = 0.13), when analysis was restricted to surgical patients with isolated surgical lead placement (n = 28), event-free survival was significantly lower in surgical patients (P = 0.015). There appeared to be an early risk (first approximately 3 months postimplantation) with surgical lead placement, primarily in LV lead-only patients. Event rates were significantly higher in LV lead-only surgical patients than in transvenous patients in the first 3 months (P = 0.006). In proportional hazards analysis comparing isolated surgical LV lead placement to transvenous lead placement, adjusted hazard ratios were 1.8 ([1.1,2.7] P = 0.02) and 1.3 ([1.0,1.7] P = 0.07) for the first 3 months and for the full duration of follow-up, respectively.
Isolated surgical LV lead placement appears to carry a small but significant upfront mortality cost, with risk extending beyond the immediate postoperative period. Long-term survival is similar, suggesting those surviving beyond this period of early risk derive the same benefit as coronary sinus lead recipients. Further work is needed to identify risk factors associated with early mortality following surgical lead placement.
虽然一部分心脏再同步治疗患者会进行外科心外膜导线植入，但关于外科手术植入导线与经静脉植入导线后生存率比较的数据有限。我们推测外科手术会增加死亡风险。
对2000年1月至2008年9月在我院连续接受外科（48例）或经皮（432例）左心室（LV）导线植入的480例患者的长期无事件生存率进行评估。
两组间基线临床和人口统计学特征相似。虽然总体无事件生存率无统计学显著差异（P = 0.13），但当分析仅限于单纯外科导线植入的手术患者（n = 28）时，手术患者的无事件生存率显著较低（P = 0.015）。外科导线植入似乎存在早期风险（主要在植入后约3个月内），主要见于仅植入LV导线的患者。仅植入LV导线的外科手术患者在前3个月的事件发生率显著高于经静脉植入患者（P = 0.006）。在比较单纯外科LV导线植入与经静脉导线植入的比例风险分析中，前3个月和整个随访期的调整风险比分别为1.8（[1.1,2.7]，P = 0.02）和1.3（[1.0,1.7]，P = 0.07）。
单纯外科LV导线植入似乎会带来小但显著的前期死亡成本，风险超出术后即刻阶段。长期生存率相似，表明那些在早期风险期后存活的患者与接受冠状窦导线植入的患者获得相同益处。需要进一步研究以确定与外科导线植入后早期死亡相关的风险因素。
