The Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
PLoS One. 2019 Apr 29;14(4):e0215589. doi: 10.1371/journal.pone.0215589. eCollection 2019.
Cardiac implantable electronic device (CIED) trans venous lead extraction (TLE) is technically challenging. Whether the use of a laser sheath reduces complications and improves outcomes is still in debate. We therefore aimed at comparing our experience with and without laser in a large referral center.
Information of all patients undergoing TLE was collected prospectively. We retrospectively compared procedural outcomes prior to the introduction of the laser sheath lead extraction technique to use of laser sheath.
During the years 2007-2017, there were 850 attempted lead removals in 407 pts. Of them, 339 (83%) were extracted due to infection, device upgrade/lead malfunction in 42 (10%) cases, and other (7%). Complete removal (radiological success) of all leads was achieved in (88%). Partial removal was achieved in another 6% of the patients. Comparison of cases prior to and after laser technique introduction, showed that with laser, a significantly smaller proportion of cases required conversion to femoral approach [31/275 (6%) laser vs. 40/132 (15%) non-laser; p<0.001]. However, success rates of removal [259/275 (94%) vs. 124/132 (94%) respectively; p = 0.83] and total complication rates [35 (13%) vs. 19 (14%) respectively; p = 0.86] did not differ prior to and after laser use. In multivariate analysis, laser-assisted extraction was an independent predictor for no need for femoral extraction (OR = 0.39; 95% CI 0.23-0.69; p = 0.01).
Introduction of laser lead removal resulted in decreased need to convert to femoral approach, albeit without improving success rates or preventing major complications.
心脏植入式电子设备（CIED）经静脉导线拔除（TLE）具有一定技术难度。激光鞘的应用是否能减少并发症并改善结局仍存在争议。因此，我们旨在比较在一家大型转诊中心应用和不应用激光鞘的经验。
前瞻性收集所有接受 TLE 患者的信息。我们回顾性比较了在引入激光鞘导线拔除技术之前与应用激光鞘之后的手术结果。
在 2007 年至 2017 年期间，有 407 名患者中的 850 次尝试进行了导线拔除。其中，339 例（83%）因感染、器械升级/导线故障而拔除，42 例（10%）因其他原因而拔除。所有导线均成功（影像学成功）拔除 88%。另外 6%的患者部分拔除。比较激光技术引入前后的病例，发现应用激光时，需要转换为股静脉入路的病例明显减少[31/275（6%）激光 vs. 40/132（15%）非激光；p<0.001]。然而，拔除成功率[259/275（94%）与 124/132（94%）；p = 0.83]和总并发症发生率[35（13%）与 19（14%）；p = 0.86]在激光使用前后并无差异。多变量分析显示，激光辅助拔除是无需股静脉入路的独立预测因素（OR = 0.39；95%CI 0.23-0.69；p = 0.01）。
尽管激光导线拔除并未提高成功率或预防严重并发症，但可降低需要转换为股静脉入路的需求。
