Martin Andrew, Voss Jamie, Shannon Duncan, Ruygrok Peter, Lever Nigel
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand.
Pacing Clin Electrophysiol. 2014 Feb;37(2):242-8. doi: 10.1111/pace.12274. Epub 2014 Jan 15.
Cardiac implantable electronic devices (CIEDs) have now become common therapeutic adjuncts for patients prior to orthotopic heart transplantation (OHT). Removal of the generator and the intracardiac components occurs at time of transplantation but removal of the intravascular portion of leads may be unsuccessful without specialized extraction equipment.
We performed a retrospective audit of chest radiographs and clinical records of patients undergoing OHT at Green Lane and Auckland City Hospitals between 2002 and 2012.
At the time of transplant surgery, 56 of 100 patients had a CIED in situ. Hardware was retained postoperatively in 22 (39%), and the CIED had been in situ for 47 (interquartile range [IQR] 16-68) months for these cases, compared to 14 (IQR 3-24) months in those without. In two (9%) patients, the device generator was electively explanted during the week following OHT. There were no subsequent procedures undertaken to remove retained lead fragments. One (4%) had lead fragment embolization, one (4%) had endoluminal fragment migration, and one (4%) had lead fragment erosion into the mediastinum; all were asymptomatic and without adverse clinical sequelae. There was no infection associated with this hardware. The presence of retained lead fragments was not associated with additional mortality.
Retained lead fragments following OHT occur commonly, without adverse clinical events for this cohort; however, the long-term clinical implications remain uncertain. Complete removal of all CIED hardware should be attempted at the time of OHT, and when this is not possible leads should be left in a state that facilitates their removal at a later date if required.
心脏植入式电子设备（CIEDs）现已成为原位心脏移植（OHT）患者常见的治疗辅助手段。在移植时需移除发生器和心内组件，但若无专门的拔除设备，可能无法成功移除导线的血管内部分。
我们对2002年至2012年间在格林莱恩和奥克兰市医院接受OHT的患者的胸部X光片和临床记录进行了回顾性审计。
在移植手术时，100例患者中有56例原位植入了CIED。22例（39%）术后保留了硬件，这些病例中CIED原位植入时间为47个月（四分位间距[IQR]16 - 68），而未保留硬件的患者为14个月（IQR 3 - 24）。在2例（9%）患者中，在OHT后的一周内选择性地取出了设备发生器。后续未进行任何移除残留导线碎片的操作。1例（4%）发生导线碎片栓塞，1例（4%）发生腔内碎片迁移，1例（4%）导线碎片侵蚀至纵隔；所有患者均无症状且无不良临床后遗症。未发现与该硬件相关的感染。残留导线碎片的存在与额外死亡率无关。
OHT后残留导线碎片很常见，该队列中无不良临床事件发生；然而，其长期临床影响仍不确定。应在OHT时尝试完全移除所有CIED硬件，若无法做到，应将导线保留在便于日后必要时移除的状态。
