Department of Cardiology, Isala Heart Centre, Zwolle, the Netherlands.
J Cardiovasc Electrophysiol. 2018 Feb;29(2):316-321. doi: 10.1111/jce.13389. Epub 2017 Nov 28.
Chronic venous occlusion hampers lead revisions and upgrades in patients with a cardiac implantable electronic devices (CIEDs). This can make cardiothoracic surgery, venoplasty, or contra-lateral implantation of leads with tunneling necessary. A technique using venous recanalization may be a preferred alternative. We assessed the efficacy and safety of this new technique.
From 2009 to 2016, all consecutive patients planned for lead revision or upgrade with known chronic venous occlusion were studied. All patients underwent extraction of an existing malfunctional or functional CIED lead with the Cook Evolution mechanical power sheath. By using the lumen of the sheath, endovascular access to the heart was obtained for new leads. Forty-two patients (107 leads, 2.6 ± 1.1) were included. The indication for this procedure was replacement of malfunctional leads (n = 35, 83%) or device upgrade (n = 7, 17%). In total, 77 leads were extracted (30 leads stayed in situ) with a mean age at time of extraction of 8.4 years. Because of damage to bystander leads during extraction, two additional leads (one RA lead, one LV lead) were extracted. Clinical success was achieved in 41 patients (97%) and complete success in 39 patients (93%). There were two minor complications (two pocket hematomas, managed conservatively) and one major complication (tamponade, needing thoracotomy). Mean procedure time was 3.0 hours (median, 2.0; range, 1:28-5:35 hours) with a mean fluoroscopy time of 14.9 ± 12.5 minutes.
The technique of Evolution-mediated recanalization in case of lead revisions or upgrades is feasible with an acceptable safety profile and high efficacy.
慢性静脉闭塞会妨碍心脏植入式电子设备 (CIED) 患者的导联修订和升级。这可能需要进行心胸外科手术、血管成形术或对侧导联隧道植入。使用静脉再通技术可能是一种首选的替代方法。我们评估了这种新技术的疗效和安全性。
从 2009 年到 2016 年，所有计划进行导联修订或升级的连续患者都进行了研究。所有患者均采用 Cook Evolution 机械动力护套提取现有功能不良或功能正常的 CIED 导联。通过使用护套的管腔，为新导联获得了通向心脏的血管内通道。共纳入 42 例患者（107 根导联，2.6±1.1）。该手术的适应证为更换功能不良的导联（n=35，83%）或设备升级（n=7，17%）。总共提取了 77 根导联（30 根导联仍留在原位），提取时的平均年龄为 8.4 岁。由于在提取过程中对相邻导联造成损害，又提取了两根导联（一根 RA 导联，一根 LV 导联）。41 例患者（97%）达到临床成功，39 例患者（93%）达到完全成功。有两例轻微并发症（两例囊袋血肿，保守治疗）和一例主要并发症（填塞，需要开胸）。平均手术时间为 3.0 小时（中位数，2.0；范围，1:28-5:35 小时），平均透视时间为 14.9±12.5 分钟。
Evolution 介导的再通技术在导联修订或升级时是可行的，具有可接受的安全性和高疗效。
