Kaya Elif, Totzeck Matthias, Rassaf Tienush
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
Eur J Med Res. 2017 Nov 21;22(1):49. doi: 10.1186/s40001-017-0292-7.
The pulsed electron avalanche knife (PEAK) PlasmaBlade™ is an innovative electrosurgical device that uses a novel technology to cut tissues. It has been proven to be safe and feasible in ear, nose, and throat surgery, but there are only limited data concerning the use of PlasmaBlade™ instead of conventional electrocautery in cardiac implantable electronic device (CIED) procedures except for generator replacements.
We conducted a retrospective, single-center study with patients undergoing CIED surgery at our center between December 2015 and March 2017 and evaluate the feasibility and the clinical outcome of the PlasmaBlade™.
282 patients (mean age 70.7 ± 12.9 years; 65.6% male) were included, of which 119 (42.2%) underwent pacemaker implantation, 95 (33.7%) implantable cardioverter defibrillator implantation, and 68 (24.1%) received a generator replacement. At the time of the procedure, 55 patients (19.5%) were on dual antiplatelet therapy, and 109 (38.7%) patients were on oral anticoagulation (30.5% vitamin K antagonists, 8.2% novel oral anticoagulants). The overall perioperative complication rate was 3.9%. Device-pocket hematoma occurred in 9 patients (3.2%) requiring further surgery. No lead damage was seen within a follow-up of 6 months. One patient presented with device-pocket infection 2.9 months after implantation of a cardiac resynchronization therapy defibrillator requiring CIED system extraction.
Replacing conventional electrocautery by PlasmaBlade™ for CIED procedures is feasible with a moderate rate of perioperative complications compared to the literature. Studies comparing the PlasmaBlade™ with conventional electrocautery are necessary to investigate whether PlasmaBlade™ offers an additional benefit over conventional electrocautery.
脉冲电子雪崩刀（PEAK）PlasmaBlade™是一种创新的电外科设备，采用新技术切割组织。它已被证明在耳鼻喉科手术中是安全可行的，但除了发生器更换外，关于在心脏植入式电子设备（CIED）手术中使用PlasmaBlade™替代传统电灼术的数据有限。
我们进行了一项回顾性单中心研究，研究对象为2015年12月至2017年3月在本中心接受CIED手术的患者，并评估PlasmaBlade™的可行性和临床结果。
纳入282例患者（平均年龄70.7±12.9岁；65.6%为男性），其中119例（42.2%）接受起搏器植入，95例（33.7%）接受植入式心律转复除颤器植入，68例（24.1%）接受发生器更换。手术时，55例患者（19.5%）接受双联抗血小板治疗，109例患者（38.7%）接受口服抗凝治疗（30.5%为维生素K拮抗剂，8.2%为新型口服抗凝剂）。围手术期总体并发症发生率为3.9%。9例患者（3.2%）发生设备囊袋血肿，需要进一步手术。在6个月的随访中未发现导线损伤。1例患者在植入心脏再同步治疗除颤器2.9个月后出现设备囊袋感染，需要取出CIED系统。
与文献报道相比，在CIED手术中用PlasmaBlade™替代传统电灼术是可行的，围手术期并发症发生率适中。有必要开展比较PlasmaBlade™与传统电灼术的研究，以探讨PlasmaBlade™是否比传统电灼术具有额外优势。
