Brigham and Women's Hospital, Boston, MA 02115, USA.
Circ Arrhythm Electrophysiol. 2012 Apr;5(2):252-7. doi: 10.1161/CIRCEP.111.965277. Epub 2012 Feb 23.
The number of cardiovascular implantable electronic devices has increased progressively and has led to an increased need for transvenous lead extraction (TLE). Multiple reports of TLE procedural outcomes exist; however, data regarding postprocedural and long-term mortality are limited.
We performed a retrospective study of consecutive patients undergoing TLE at a single, high-volume center. Patient characteristics, indications, and outcomes were analyzed. A multivariable Cox regression model was developed to identify factors associated with mortality. Between January 2000 and December 2010, 985 patients underwent 1043 TLE procedures. The cohort was 68% male, with a mean age of 63 years (range, 15-95 years) and a left ventricular ejection fraction of 40±17%. Indications included systemic infection (18%), pocket infection (32%), lead malfunction (30%), and other (device upgrade, venous occlusion, and advisory leads; 20%). There were no procedure-related deaths. The mean follow-up was 3.7 years (range, 0.1-11.3 years). Kaplan-Meier analysis demonstrated a cumulative mortality of 2.1% at 30 days, 4.2% at 3 months, 8.4% at 1 year, and 46.8% at 10 years. In multivariable analysis, systemic infection (hazard ratio [HR], 3.52; 95% CI, 1.95-6.38; P<0.0001), local infection (HR, 2.70; 95% CI, 1.55-4.67; P=0.0004), device system upgrade (HR, 2.14; 95% CI, 1.07-4.25; P=0.03; indication compared with a reference group of extraction for lead malfunction), diabetes mellitus (HR, 1.71; 95% CI, 1.25-2.35; P=0.0009), increasing age (HR, 1.05; 95% CI, 1.04-1.07; P<0.0001), and serum creatinine (HR, 1.16; 95% CI, 1.01-1.35; P=0.04) were significant correlates of increased mortality risk.
Although TLE procedural mortality is exceedingly low at high-volume centers, postprocedural and long-term mortality remain high in certain patient populations, such as elderly patients and those undergoing TLE for infectious indications and device system upgrade. Information regarding TLE long-term outcomes may help guide cardiovascular implantable electronic device and lead management.
心血管植入式电子设备的数量不断增加，导致经静脉导线拔除（TLE）的需求也不断增加。有多项关于 TLE 手术结果的报告，但关于术后和长期死亡率的数据有限。
我们对一家高容量中心连续接受 TLE 治疗的患者进行了回顾性研究。分析了患者的特征、适应证和结局。建立了多变量 Cox 回归模型，以确定与死亡率相关的因素。2000 年 1 月至 2010 年 12 月，985 例患者接受了 1043 例 TLE 手术。该队列中 68%为男性，平均年龄为 63 岁（范围 15-95 岁），左心室射血分数为 40±17%。适应证包括全身感染（18%）、囊袋感染（32%）、导线故障（30%）和其他（器械升级、静脉闭塞和警示导线；20%）。无手术相关死亡。平均随访时间为 3.7 年（范围 0.1-11.3 年）。Kaplan-Meier 分析显示，术后 30 天、3 个月、1 年和 10 年的累积死亡率分别为 2.1%、4.2%、8.4%和 46.8%。多变量分析显示，全身感染（风险比[HR]，3.52；95%置信区间[CI]，1.95-6.38；P<0.0001）、局部感染（HR，2.70；95%CI，1.55-4.67；P=0.0004）、器械系统升级（HR，2.14；95%CI，1.07-4.25；P=0.03；与导线故障的提取适应证相比）、糖尿病（HR，1.71；95%CI，1.25-2.35；P=0.0009）、年龄增加（HR，1.05；95%CI，1.04-1.07；P<0.0001）和血清肌酐（HR，1.16；95%CI，1.01-1.35；P=0.04）是死亡率增加的显著相关因素。
尽管在高容量中心 TLE 手术死亡率极低，但在某些患者群体中，如老年患者以及因感染和器械系统升级而接受 TLE 的患者，术后和长期死亡率仍然较高。关于 TLE 长期结果的信息可能有助于指导心血管植入式电子设备和导线的管理。
