Hansky Bert, Kaymer Wolfgang, zu Vilsendorf Dorothee Meyer, Strunk-Müller Claudia, Stellbrink Christoph
Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bielefeld, Bielefeld, Germany.
Herzschrittmacherther Elektrophysiol. 2013 Sep;24(3):158-64. doi: 10.1007/s00399-013-0282-6.
Special tools for lead removal enables transvenous lead extractions without cardiac exposure. The risk of fatal complications during extraction of long-term implanted leads requires detailed knowledge and trained physicians. In addition to patients’ age and gender, individual extraction risk factors are access and time since implantation, lead position, kind and number of leads. Locking stylets to anchor the lead within the lumen are necessary in all extraction procedures while the use of external sheaths is optional. Higher risk of cardiac or central vein perforation during lead mobilisation with external laser sheaths has to be respected, and these tools should be used with strong indication only. In cases of high risk, lead explantation with an open heart procedure should be considered as an alternative.
用于取出导线的特殊工具可实现经静脉导线取出术而无需打开心脏。取出长期植入导线过程中发生致命并发症的风险需要详细的知识和训练有素的医生。除了患者的年龄和性别外，个体取出风险因素还包括入路、植入后的时间、导线位置、导线的种类和数量。在所有取出手术中，使用锁定探针将导线固定在管腔内都是必要的，而使用外部鞘管则是可选的。使用外部激光鞘管进行导线松动时，发生心脏或中心静脉穿孔的风险较高，必须予以重视，且这些工具仅应在有强烈指征时使用。在高风险情况下，应考虑采用心脏直视手术取出导线作为替代方案。
