Kutarski Andrzej, Polewczyk Anna, Boczar Krzysztof, Ząbek Andrzej, Polewczyk Maciej
2nd Department of Clinical Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland.
Cardiol J. 2014;21(1):47-52. doi: 10.5603/CJ.a2013.0084. Epub 2013 Jun 25.
There is a considerable controversy regarding safety of transvenous lead extraction (TLE) in elderly patients due to their potentially worse general condition, more concomitant diseases, more difficult sedation or analgesia. Moreover, the present experience is not relevant. The aim of the study was the comparison of safety and feasibility of TLE in elderly and middle-aged patients.
We have extracted an ingrown pacemaker (PM)/implantable cardioverter-defibrillator (ICD) leads from 1,060 adult patients (21-70 years) and 192 octogenarians (mean age 83.4 ± 3.1 years) using standard mechanical systems within the last 7 years. We compared effectiveness and complications of the TLE procedures in the two mentioned groups of patients.
There were more women in octogenarians referred for TLE (45.3% vs. 36.9%). In addition, more pocket infections (37.0% vs. 24.5%), less non-infective indications for PM (46.9% vs. 57.7%) and ICD systems (7.3% vs. 28.8%) TLE were observed in this group. Leads body dwelling time was similar (76.4 ± 56.8 vs. 83.5 ± 63.0) in both groups. Procedure efficacy (full radiological success 97.4% vs. 94.6%, partial radiological success 2.6% vs. 4.34%), safety measures (major complications 1.6% vs. 1.51%, minor complications 1.0% vs. 1.9%) were similar in both compared groups.
Old age does not influence TLE effectiveness. Therefore, TLE can be safely and successfully performed in octogenarians.
由于老年患者的一般状况可能较差、合并疾病更多、镇静或镇痛更困难，经静脉导线拔除术（TLE）在老年患者中的安全性存在相当大的争议。此外，目前的经验并不适用。本研究的目的是比较老年和中年患者TLE的安全性和可行性。
在过去7年中，我们使用标准机械系统从1060例成年患者（21 - 70岁）和192例八旬老人（平均年龄83.4±3.1岁）中拔除了植入性心脏起搏器（PM）/植入式心律转复除颤器（ICD）导线。我们比较了上述两组患者TLE手术的有效性和并发症。
接受TLE的八旬老人中女性更多（45.3%对36.9%）。此外，该组中观察到更多的囊袋感染（37.0%对24.5%）、PM（46.9%对57.7%）和ICD系统（7.3%对28.8%）TLE的非感染性指征更少。两组导线体内留置时间相似（76.4±56.8对83.5±63.0）。比较的两组手术疗效（完全放射学成功97.4%对94.6%，部分放射学成功2.6%对4.34%）、安全措施（主要并发症1.6%对1.51%，次要并发症1.0%对1.9%）相似。
高龄不影响TLE的有效性。因此，八旬老人可以安全、成功地进行TLE。
