Pecha Simon, Castro Liesa, Vogler Julia, Linder Matthias, Gosau Nils, Willems Stephan, Reichenspurner Hermann, Hakmi Samer
Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany.
Department of Cardiology, Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
Heart Vessels. 2018 Oct;33(10):1245-1250. doi: 10.1007/s00380-018-1162-0. Epub 2018 Apr 5.
We investigated the effect of systemic infection or lead endocarditis on the complexity and the success of laser lead extraction (LLE) procedures. Medical records of all patients undergoing LLE between January 2012 and March 2017 were screened with regard to information on systemic infection or lead endocarditis. We treated 184 patients using high-frequency 80 Hz laser sheaths in patients with lead implant duration of ≥ 12 months. Indications for lead extraction were systemic infection and lead endocarditis in 52 cases (28.3%), local infection in 74 cases (40.2%), lead dysfunction in 37 cases (20.1%) and other indications in 21 cases (11.4%). 386 leads were scheduled for LLE: 235 (60.9%) pacing, 105 (27.2%) ICD and 46 (11.9%) CS leads. The mean time from initial lead implantation (systemic infection 96.8 ± 74.7 months vs. 102.1 ± 82.6 non-infected: months; p = 0.4155) and ratio of ICD leads (26.8 vs. 27.4%; p = 0.3411) did not differ significantly between the two groups. Complete procedural success was significantly higher in the systemic infection group (100 vs. 94.7%; p = 0.0077). The mean laser treatment (60.2 ± 48.7 vs. 72.4 ± 61.5 s; p = 0.2038) was numerically lower in the infection group, while fluoroscopy time (9.3 ± 7.6 vs. 12.8 ± 10.3 min; p = 0.0275) was significantly lower in this group. Minor and major complications were low in both groups and did not reveal any statistically significant difference (infected group: one minor complication; pocket hematoma, non-infected: three major complications; emergent sternotomy due to pericardial tamponade). No extraction related mortality was observed. The presence of systemic infection or lead endocarditis in LLE procedures allows for higher complete procedural success. When compared with LLE of non-infected leads, the infected leads require less laser and fluoroscopy times. Due to the scarcity of minor and major complications in general, no statistical significance was found in that regard.
我们研究了全身感染或导线心内膜炎对激光导线拔除（LLE）手术的复杂性和成功率的影响。对2012年1月至2017年3月期间所有接受LLE手术的患者的病历进行筛查，以获取有关全身感染或导线心内膜炎的信息。我们对184例导线植入时间≥12个月的患者使用高频80Hz激光鞘进行治疗。导线拔除的适应证包括52例（28.3%）的全身感染和导线心内膜炎、74例（40.2%）的局部感染、37例（20.1%）的导线功能障碍以及21例（11.4%）的其他适应证。计划进行LLE的导线有386根：235根（60.9%）为起搏导线，105根（27.2%）为植入式心律转复除颤器（ICD）导线，46根（11.9%）为冠状窦（CS）导线。两组患者从最初导线植入的平均时间（全身感染组为96.8±74.7个月，非感染组为102.1±82.6个月；p = 0.4155）以及ICD导线的比例（分别为26.8%和27.4%；p = 0.3411）差异均无统计学意义。全身感染组的手术完全成功率显著更高（分别为100%和94.7%；p = 0.0077）。感染组的平均激光治疗时间在数值上更低（分别为60.2±48.7秒和72.4±61.5秒；p = 0.2038），而该组的透视时间显著更低（分别为9.3±7.6分钟和12.8±10. minutes；p = 0.0275）。两组的轻微和严重并发症发生率均较低，且未显示出任何统计学上的显著差异（感染组：1例轻微并发症；囊袋血肿，非感染组：3例严重并发症；因心包填塞行急诊胸骨切开术）。未观察到与拔除相关的死亡病例。LLE手术中全身感染或导线心内膜炎的存在可使手术完全成功率更高。与非感染导线的LLE相比，感染导线所需的激光和透视时间更少。由于总体上轻微和严重并发症较少，在这方面未发现统计学意义。
