From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.).
Circ Arrhythm Electrophysiol. 2018 Feb;11(2):e004768. doi: 10.1161/CIRCEP.116.004768. Epub 2018 Feb 16.
Transvenous lead extraction is an integral part of management of patients with cardiovascular implantable electronic devices. Real-world incidence and predictors of perioperative complications in extractions involving implantable cardioverter-defibrillator leads have not been described in detail.
Data from the National Cardiovascular Data Registry Implantable Cardioverter-Defibrillator Registry were analyzed. Lead extraction was defined as removal of leads implanted for >1 year. Predictors of major perioperative complications for all extraction procedures (11 304) and for high-voltage lead (8362, 74%), across 762 centers, were analyzed using univariate and multivariate logistic regression. Major complication occurred in 258 (2.3%) extraction procedures. Of these 258 with a complication, 41 (16%) required urgent cardiac surgery. Of these 41, 14 (34%) died during surgery. Among the total 98 (0.9%) deaths reported, 18 (0.16% of total) occurred during transvenous lead extraction. In multivariable logistic regression analysis, female sex, admission other than electively for procedure, ≥3 leads extracted, longer implant duration, dislodgement of other leads, and patient's clinical status requiring lead extraction (infection/perforation) were associated with increased risk of complications. Smaller lead diameter, flat versus round coil shape, and greater proximal surface coil area were multivariate predictors of major perioperative complications specific to high-voltage leads.
The rate of major complications and mortality with transvenous lead extraction is similar in the real-world outcomes to that reported in recent single-center studies from high-volume centers. There is significant risk of urgent cardiac surgery, which carries a high mortality, and planning for appropriate cardiothoracic surgery backup is imperative.
经静脉导线拔除术是心血管植入式电子设备管理的重要组成部分。在涉及植入式心脏复律除颤器导线的拔除手术中，尚未详细描述围手术期并发症的实际发生率和预测因素。
分析了全国心血管数据注册植入式心脏复律除颤器登记处的数据。导线拔除术定义为植入超过 1 年的导线的移除。使用单变量和多变量逻辑回归分析了 762 个中心的所有拔除手术（11304 例）和高电压导线（8362 例，占 74%）的主要围手术期并发症的预测因素。258 例（2.3%）拔除手术出现严重并发症。在这 258 例并发症中，41 例（16%）需要紧急心脏手术。其中 14 例（34%）在手术期间死亡。在报告的 98 例总死亡人数中，18 例（占总死亡人数的 0.16%）发生在经静脉导线拔除术中。多变量逻辑回归分析表明，女性、非择期入院、≥3 根导线拔除、植入时间延长、其他导线脱位、以及因感染/穿孔而需要进行导线拔除的患者临床状态与并发症风险增加相关。较小的导线直径、扁平与圆形线圈形状、以及更大的近端线圈面积是高电压导线发生主要围手术期并发症的多变量预测因素。
在真实世界的结果中，经静脉导线拔除术的主要并发症和死亡率与最近来自高容量中心的单中心研究报告的结果相似。需要紧急心脏手术的风险很大，死亡率很高，因此必须规划适当的心胸外科手术后备。
