Department of Cardiac Surgery and Transplantology, Institute of Cardiology, Warsaw, Poland.
Kardiol Pol. 2013;71(2):159-63. doi: 10.5603/KP.2013.0009.
An increasing number of patients is referred for orthotopic heart transplantation (OHT) after previous implantable cardioverter-defibrillator (ICD) or cardiac resynchronisation therapy (CRT) device implantation.
To assess the rate of unsuccessful lead extractions during OHT and propose an appropriate management algorithm.
The study population included 73 consecutive patients who underwent OHT in our hospital between January 2009 and December 2011.
In the study group, 36 (49.3%) patients previously underwent ICD (21 patients, 28.8%) or CRT (15 patients, 20.5%) implantation. In 29 patients, all previously implanted leads were completely removed during transplantation. In 7 (19.5%) patients, fragments of the leads could not be removed and were abandoned due to their adherence to the venous system, including a proximal defibrillation coil in 6 cases and a fragment of a left ventricular lead in 1 case. All abandoned lead fragments were extracted after the transplantation (10-70 days, mean 27 days) either with manual traction techniques (1 case, left ventricular lead), or with the assistance of lead extraction sheaths (6 cases, dual-coil defibrillation leads). Due to lead fracture, it was necessary to use femoral approach in 1 case. No complications of lead extraction were noted.
In a significant number of patients, previously implanted leads cannot be removed during OHT. Therefore, abandoned lead fragments should be removed after the transplantation using transvenous lead extraction techniques.
越来越多的患者在先前植入植入式心脏复律除颤器（ICD）或心脏再同步治疗（CRT）装置后被转诊接受原位心脏移植（OHT）。
评估 OHT 期间不成功的导联取出率，并提出适当的管理算法。
研究人群包括 2009 年 1 月至 2011 年 12 月期间在我院接受 OHT 的 73 例连续患者。
在研究组中，36 例（49.3%）患者先前接受过 ICD（21 例，28.8%）或 CRT（15 例，20.5%）植入。在 29 例患者中，所有先前植入的导联在移植过程中均被完全取出。在 7 例（19.5%）患者中，由于导联与静脉系统粘连，无法取出导联碎片而被放弃，其中 6 例为近端除颤线圈，1 例为左心室导联碎片。所有被放弃的导联碎片均在移植后（10-70 天，平均 27 天）通过手动牵引技术（1 例，左心室导联）或使用导联提取鞘（6 例，双线圈除颤导联）取出。由于导联断裂，1 例需要使用股动脉入路。未观察到导联提取并发症。
在相当数量的患者中，先前植入的导联在 OHT 期间无法取出。因此，应使用经静脉导联提取技术在移植后取出被放弃的导联碎片。
