Department of Electrophysiology, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
Department of Cardiovascular Surgery, University Heart Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
Eur J Cardiothorac Surg. 2018 Oct 1;54(4):745-751. doi: 10.1093/ejcts/ezy106.
As the number of transvenous lead extractions continues to increase, preprocedural protocols for this procedure must be assessed. The objective of this study was to determine whether an electrocardiogram (ECG)-triggered computed tomography (Et-CT) with three-dimensional (3D) reconstructions could aid lead extractors in choosing the optimal tools to improve procedural success and avoid complications.
In this study, 31 patients scheduled for transvenous lead extraction underwent a preprocedural Et-CT between January 2016 and May 2017. Both 3D-reconstructions and the two-dimensional files were reviewed for possible lead adhesions, calcifications, migrations or perforations.
Mean age was 46.7 ± 14.0 years. Seventy-one percent of patients were men, and 29.0% had undergone prior cardiac surgery. Indications for extraction included infection (n = 18, 58.1%), lead dysfunction (n = 8, 25.8%), upgrade (n = 3, 9.7%), severe tricuspid regurgitation (n = 1, 3.2%) and superior vena cava occlusion (n = 1, 3.2%). Eighteen patients had an implantable cardioverter defibrillator (58.1%). Sixty-eight of 70 targeted leads were extracted with a mean of 2.2 leads per patient and an average lead age of 109.3 ± 58.7 months. Et-CT files supported transvenous lead extraction by revealing possible adhesions in 16 patients, 5 perforations and 2 venous occlusions. Lead extraction was performed using the excimer laser, mechanical tools and femoral snares. Complete procedural success was achieved in 93.5% (n = 29) of cases. Clinical success was 100%, and intraoperative mortality was 0%.
A preprocedural Et-CT with 3D reconstructions can help to visualize lead alignment and identify abnormalities that may foreshadow procedural difficulties. A preprocedural Et-CT may therefore aid lead extractors in choosing the optimal extraction tool and strategy.
随着经静脉导线拔除术数量的不断增加，必须对该手术的术前方案进行评估。本研究旨在确定心电图（ECG）触发的计算机断层扫描（Et-CT）结合三维（3D）重建是否有助于导线拔除术医生选择最佳工具，以提高手术成功率并避免并发症。
本研究共纳入 31 例拟行经静脉导线拔除术的患者，于 2016 年 1 月至 2017 年 5 月期间进行术前 Et-CT。对 3D 重建和二维文件进行评估，以发现可能的导线粘连、钙化、迁移或穿孔。
患者平均年龄为 46.7±14.0 岁。71%的患者为男性，29.0%曾接受过心脏手术。拔除导线的指征包括感染（18 例，58.1%）、导线功能障碍（8 例，25.8%）、升级（3 例，9.7%）、严重三尖瓣反流（1 例，3.2%）和上腔静脉阻塞（1 例，3.2%）。18 例患者植入了植入式心律转复除颤器（58.1%）。70 根目标导线中，68 根被成功拔除，平均每位患者拔除 2.2 根导线，平均导线使用年龄为 109.3±58.7 个月。Et-CT 显示 16 例患者可能存在粘连，5 例穿孔和 2 例静脉阻塞，为经静脉导线拔除术提供了支持。使用准分子激光、机械工具和股静脉套圈进行了导线拔除。93.5%（29 例）的患者手术取得完全成功。临床成功率为 100%，术中无死亡。
术前 Et-CT 结合 3D 重建可以帮助观察导线的位置和发现可能预示手术困难的异常。因此，术前 Et-CT 可以帮助导线拔除术医生选择最佳的拔除工具和策略。
