Department of Cardiology, Isala Hospital, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands
Department of Cardiology, Isala Hospital, Dr Van Heesweg 2, 8025 AB Zwolle, The Netherlands.
Europace. 2016 May;18(5):762-6. doi: 10.1093/europace/euv243. Epub 2015 Oct 14.
The Evolution sheath (Cook, USA) is a power sheath with a cutting screw tip operated by mechanical rotation. It has been reported to be an effective tool for chronic lead extraction. We evaluated the safety and efficacy of this system.
From 2009 to 2014, all lead extractions requiring the use of an Evolution sheath were prospectively examined. In 77 patients, 111 leads were extracted. The first 57 leads were extracted with the original unidirectional sheath, and since 2013, 54 leads were extracted with the bidirectional R/L type. According to the current guidelines, complete procedural success was defined as the removal of all targeted lead material. Clinical success was the retention of a small portion of the lead, and failure was the inability to achieve either complete procedural or clinical success or the development of any permanently disabling complication. The Evolution sheath was used to extract 111 leads in 77 patients. The median age of the lead at time of extraction was 8.0 years (median 6.9, interquartile range 6.4, minimum: 0.6 and maximum: 34.4), with a clinical success rate of 98% and a complete procedural success of 88%. Complete procedural success was higher for the R/L type Evolution sheath (96 vs. 80%, P = 0.006). There were 21 (19%) implantable cardioverter defibrillator leads, 22 (20%) right ventricular pacing leads, 60 (54%) right atrial leads, and 8 (7%) left ventricular leads. There were no major complications and six (8%) minor complications. There was no need for the usage of a femoral tool or snares.
Use of Evolution for lead extractions seems to be safe and effective, with a high clinical success rate.
Evolution 鞘（美国 Cook 公司）是一种带有切割螺丝尖端的电动鞘管，通过机械旋转操作。它已被报道为一种有效的慢性 Lead 提取工具。我们评估了该系统的安全性和有效性。
2009 年至 2014 年，所有需要使用 Evolution 鞘进行 Lead 提取的病例均进行前瞻性检查。在 77 名患者中，共提取了 111 根 Lead。前 57 根 Lead 使用原始的单向鞘管进行提取，自 2013 年以来，54 根 Lead 使用双向 R/L 型鞘管进行提取。根据现行指南，完全程序成功定义为去除所有目标 Lead 材料。临床成功定义为保留一小部分 Lead，失败定义为无法实现完全程序或临床成功，或出现任何永久性致残并发症。Evolution 鞘管共用于 77 名患者的 111 根 Lead 提取。提取时 Lead 的中位年龄为 8.0 岁（中位数 6.9，四分位距 6.4，最小值：0.6，最大值：34.4），临床成功率为 98%，完全程序成功率为 88%。R/L 型 Evolution 鞘管的完全程序成功率更高（96%比 80%，P = 0.006）。有 21 根（19%）植入式心脏复律除颤器 Lead、22 根（20%）右心室起搏 Lead、60 根（54%）右心房 Lead 和 8 根（7%）左心室 Lead。无重大并发症，有 6 例（8%）轻微并发症。无需使用股动脉工具或套圈。
使用 Evolution 进行 Lead 提取似乎是安全有效的，临床成功率高。
