Bontempi Luca, Vassanelli Francesca, Cerini Manuel, Bisleri Gianluigi, Repossini Alberto, Giroletti Laura, Inama Lorenza, Salghetti Francesca, Liberto Daria, Giacopelli Daniele, Raweh Abdallah, Muneretto Claudio, Curnis Antonio
Division of Cardiology, Spedali Civili Hospital, Brescia, Italy.
Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy.
J Cardiovasc Electrophysiol. 2017 Apr;28(4):466-473. doi: 10.1111/jce.13164. Epub 2017 Feb 9.
Despite the overall safety, transvenous lead extraction (TLE) remains a challenging procedure with inherent risks, where surgery can still be required in elective cases. In this study, we report our experience with a minimally invasive "hybrid" approach, defined as a procedure performed by an electrophysiologist with the support of a cardiac surgeon in the same operative session.
We reported 12 cases of planned hybrid lead extraction; minithoracotomy and thoracoscopy were performed on 10 (83%) and 2 (17%) patients, respectively. A total of 25 leads out of 27 (median lead age 19 years) were successfully extracted with laser, mechanical or combined transvenous sheath. In 3 patients, the direct monitoring of vascular and myocardial integrity allowed for prompt treatment of potential vascular injury during the lead extraction maneuvers. Mean in-hospital stay was 4 ± 2 days. There were no major intraoperative complications and no deaths occurred after 30 days' follow-up.
The hybrid approach, with minithoracotomy or thoracoscopy, is feasible and it might increase the safety in the most challenging TLE procedures: the minimally invasive surgical intervention allows for continuous monitoring of the critical cardiac structures and prompt treatment of potential complications.
尽管经静脉导线拔除术（TLE）总体安全，但仍是一项具有固有风险的挑战性手术，在择期病例中仍可能需要进行外科手术。在本研究中，我们报告了我们采用微创“杂交”方法的经验，该方法定义为由电生理学家在心脏外科医生的支持下于同一手术过程中进行的手术。
我们报告了12例计划进行的杂交导线拔除术；分别对10例（83%）和2例（17%）患者进行了微创开胸手术和胸腔镜检查。27根导线中的25根（导线中位使用年限为19年）通过激光、机械或联合经静脉鞘成功拔除。在3例患者中，对血管和心肌完整性的直接监测使得在导线拔除操作过程中能够及时处理潜在的血管损伤。平均住院时间为4±2天。术中无重大并发症，30天随访后无死亡病例。
采用微创开胸手术或胸腔镜检查的杂交方法是可行的，并且可能会提高最具挑战性的经静脉导线拔除术的安全性：微创外科干预可对关键心脏结构进行持续监测，并能及时处理潜在并发症。
