Goyal Sandeep K, Ellis Christopher R, Ball Stephen K, Ahmad Rashid, Hoff Steven J, Whalen S Patrick, Rottman Jeffrey
Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Cardiovasc Electrophysiol. 2014 Jun;25(6):617-21. doi: 10.1111/jce.12368. Epub 2014 Feb 13.
Transvenous pacemaker or implantable cardioverter defibrillator (ICD) lead extraction via mechanical or excimer laser sheath is typically safe and effective. Longer duration from implant, presence of large vegetations or thrombi, fractured leads, and prior failed extraction are risk factors predicting higher complication rates or incomplete or failed lead removal. Techniques developed for minimally invasive valve surgery were used in conjunction with laser extraction to refine a "hybrid" technique for lead extraction. We assessed the outcomes of high-risk lead extraction using this hybrid lead extraction technique.
Retrospective assessment of clinical parameters and procedural outcomes in patients undergoing planned hybrid lead extraction from February 2008 to September 2012 was performed. We report 8 cases of hybrid lead extraction performed at our institution. We extracted 21 leads with average lead age of 13.8 years since implant. All leads were removed with complete clinical and radiographic success. There were no intraprocedure complications. One patient died of continued sepsis and 1 other had symptoms consistent with pulmonary embolism.
Hybrid lead extraction using this technique is a safe and effective approach for removal of high-risk chronic pacemaker or ICD leads. This method extends the range of approachable leads resulting in complete removal without median sternotomy. Hybrid lead extraction can be scheduled electively facilitating complete lead removal with a low complication rate and short postoperative recovery time, mitigating the risks inherent in midline sternotomy or emergent cardiac surgical rescue.
经静脉起搏器或植入式心脏复律除颤器（ICD）导线通过机械或准分子激光鞘管拔除通常是安全有效的。植入时间较长、存在大的赘生物或血栓、导线断裂以及既往拔除失败是预测较高并发症发生率或导线拔除不完全或失败的危险因素。为微创瓣膜手术开发的技术与激光拔除相结合，完善了一种用于导线拔除的“杂交”技术。我们评估了使用这种杂交导线拔除技术进行高风险导线拔除的结果。
对2008年2月至2012年9月计划进行杂交导线拔除的患者的临床参数和手术结果进行回顾性评估。我们报告了在我们机构进行的8例杂交导线拔除病例。我们拔除了21根导线，自植入以来导线平均使用年限为13.8年。所有导线均成功拔除，临床和影像学检查均显示成功。术中无并发症。1例患者死于持续败血症，另1例出现与肺栓塞相符的症状。
使用这种技术进行杂交导线拔除是一种安全有效的方法，可用于拔除高风险的慢性起搏器或ICD导线。这种方法扩大了可拔除导线的范围，无需正中胸骨切开术即可完全拔除。杂交导线拔除可择期安排，有助于完全拔除导线，并发症发生率低，术后恢复时间短，降低了正中胸骨切开术或紧急心脏手术救援的固有风险。
