Ter Horst I A H, Kuijpers Y, van 't Sant J, Tuinenburg A E, Cramer M J, Meine M
Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Facility of Medicine, Utrecht University, Utrecht, The Netherlands.
Neth Heart J. 2016 Jan;24(1):75-81. doi: 10.1007/s12471-015-0771-9.
The objective of the study was to examine whether cardiac resynchronisation therapy upgrade procedures are more complex and associated with more complications than de novo implantations.
We retrospectively compared 134 upgrade procedures performed between 2006-2012 with a random, equally sized, sample of de novo CRT device implantations in the same period. Procedural data and the occurrence of periprocedural (≤ 30 days) and long-term device-related (≤ 1 year) complications were analysed. Complications with consequences were defined as those in need of adjustment of standard care.
Median time to upgrade was 57 (31-115) months. There were no significant differences in procedure duration, radiation time or total hospitalisation between upgrades and de novo implantations. Perioperative complications occurred in 6.7 % of upgrade patients and in 9.0 % of de novo patients. The most frequently seen complications were phrenic nerve stimulation, coronary sinus dissection and pocket haematoma. Procedure success was comparable (upgrade: 98.5 % versus de novo: 96.3 %). A total of 236 patients completed 1 year of follow-up. Ten (4.2 %) patients had a long-term device-related complication with consequences including phrenic nerve stimulation, lead dislodgement/dysfunction, and infection (upgrade: 3.5 % versus de novo: 4.9 %).
Upgrade procedures are not more complex nor associated with more complications than de novo CRT implantations.
本研究的目的是检验心脏再同步治疗升级手术是否比初次植入手术更复杂且并发症更多。
我们回顾性比较了2006年至2012年间进行的134例升级手术与同期随机抽取的、数量相等的初次心脏再同步治疗（CRT）设备植入样本。分析了手术数据以及围手术期（≤30天）和长期设备相关（≤1年）并发症的发生情况。有后果的并发症定义为需要调整标准护理的并发症。
升级的中位时间为57（31 - 115）个月。升级手术与初次植入手术在手术持续时间、辐射时间或总住院时间方面无显著差异。6.7%的升级患者和9.0%的初次植入患者发生围手术期并发症。最常见的并发症是膈神经刺激、冠状窦夹层和囊袋血肿。手术成功率相当（升级：98.5% 对初次植入：96.3%）。共有236例患者完成了1年的随访。10例（4.2%）患者出现了有后果的长期设备相关并发症，包括膈神经刺激、导线移位/功能障碍和感染（升级：3.5% 对初次植入：4.9%）。
升级手术并不比初次CRT植入手术更复杂，并发症也不更多。
