Pecha Simon, Linder Matthias, Gosau Nils, Castro Liesa, Vogler Julia, Willems Stephan, Reichenspurner Hermann, Hakmi Samer
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
Eur J Cardiothorac Surg. 2017 May 1;51(5):902-905. doi: 10.1093/ejcts/ezw425.
Extraction of chronically implanted cardiac implantable electrophysiological devices leads can be difficult. Excimer laser-assisted extraction with 40 Hz sheaths has shown good results in challenging cases. In 2012, a new 80 Hz high-frequency laser sheath became available that delivers twice as many pulses per second. Here, we report our clinical experience with the new GlideLight 80 Hz laser sheath.
Between January 2012 and August 2016, 292 leads were treated in 151 patients using 80 Hz GlideLight laser sheath. Lead extraction indications included systemic infection or lead endocarditis n = 35 (23.2%), local infection n = 73 (48.3%), lead dysfunction n = 32 (21.2%), system upgrade n = 5 (3.3%), tricuspid regurgitation n = 3 (2.0%) and other indications n = 3 (2.0). All patient-related and procedural data were collected into a database and analysed.
Mean patient's age was 66.2 ± 14.4 years, 73.5% were male. Ninety-one (31.2%) atrial, 159 (54.4%) ventricular and 42 (14.4%) coronary sinus leads had to be extracted. The mean time from initial lead implantation was 98.0 ± 65.2 months. Mean laser treatment time was 67.5 ± 71.3 s, mean laser pulses delivered were 5130 ± 6592. Clinical success was achieved in 99.3% of the cases, while complete procedural success was observed in 96.7%. A failure of extraction was seen in 2 (1.3%) patients. An overall complication rate of 2.0%, including two major (1.3%) and one minor (0.7%) complications, was observed. No periprocedural mortality was seen.
The new GlideLight high-frequency laser sheath allows for a high safety and efficacy in extraction of chronically implanted pacemaker- and implantable cardioverter-defibrillator leads.
长期植入的心脏植入式电生理设备导线的拔除可能具有挑战性。准分子激光辅助结合40Hz鞘管拔除术在复杂病例中已显示出良好效果。2012年，一种新型的80Hz高频激光鞘管问世，其每秒发射的脉冲数量是之前的两倍。在此，我们报告使用新型GlideLight 80Hz激光鞘管的临床经验。
在2012年1月至2016年8月期间，151例患者的292根导线使用80Hz GlideLight激光鞘管进行了处理。导线拔除指征包括全身性感染或导线心内膜炎n = 35例（23.2%）、局部感染n = 73例（48.3%）、导线功能障碍n = 32例（21.2%）、系统升级n = 5例（3.3%）、三尖瓣反流n = 3例（2.0%）以及其他指征n = 3例（2.0%）。所有与患者相关的和手术相关的数据均收集到数据库中并进行分析。
患者平均年龄为66.2±14.4岁，73.5%为男性。需要拔除91根（31.2%）心房导线、159根（54.4%）心室导线和42根（14.4%）冠状静脉窦导线。从最初植入导线到此次处理的平均时间为98.0±65.2个月。平均激光治疗时间为67.5±71.3秒，平均发射的激光脉冲数为5130±6592个。99.3%的病例获得了临床成功，96.7%观察到了完全手术成功。2例（1.3%）患者拔除失败。观察到总体并发症发生率为2.0%，包括2例严重并发症（1.3%）和1例轻微并发症（0.7%）。未观察到围手术期死亡。
新型GlideLight高频激光鞘管在长期植入的起搏器和植入式心脏复律除颤器导线拔除中具有较高的安全性和有效性。
