University of Miami Miller School of Medicine, Miami, Florida.
University of Miami Miller School of Medicine, Miami, Florida.
Heart Rhythm. 2020 Apr;17(4):646-653. doi: 10.1016/j.hrthm.2019.11.015. Epub 2019 Nov 19.
Small vegetations (<2.0 cm) associated with infected cardiac device leads can be managed percutaneously, whereas larger vegetations typically are removed via open heart surgery. Unfortunately, many patients with intracardiac vegetations are not candidates for open removal.
The purpose of this study was to report our experience in the outcomes associated with the percutaneous management of large vegetations.
Prospective data from January 2010 to August 2018 identified 826 patients with infections undergoing lead extraction. One hundred nineteen cases had vegetations measured in 2 dimensions (length and width) by transesophageal echocardiogram. Thirty-two patients had 3 characteristics: (1) at least 1 vegetation dimension ≥2.0 cm; (2) not a surgical candidate; and (3) had undergone transvenous lead extraction. The cohort was classified into 2 groups according to shape: (1) globular if the difference between dimensions was <30% between dimensions; and (2) nonglobular if the difference was >30%. The Fisher exact test and Pearson t test were used for analysis. P <.05 was considered significant.
Retrospective analysis of a single tertiary cardiac surgery center registry showed a significantly lower chance of being alive at discharge in patients with globular vegetations compared to patients with nonglobular vegetations (P = .002).
Vegetation size is an important determinant of outcomes in patients who are not surgical candidates undergoing transvenous lead extraction. However, vegetation shape is also a relevant factor, as globular vegetations may predict a worse result compared to nonglobular vegetations.
与感染性心内器械导线相关的小赘生物（<2.0cm）可经皮处理，而较大的赘生物通常需通过心脏直视手术切除。遗憾的是，许多心内赘生物患者不适合进行开放切除。
本研究旨在报告我们在经皮处理大赘生物相关结局方面的经验。
2010 年 1 月至 2018 年 8 月前瞻性收集的 826 例感染性器械导线拔除患者资料，196 例患者经食管超声心动图（TEE）测量了 2 个维度（长度和宽度）的赘生物。32 例患者满足以下 3 个特征：（1）至少 1 个赘生物维度≥2.0cm；（2）不适合手术；（3）经静脉导线拔除。根据形状将该队列分为 2 组：（1）如果 2 个维度之间的差异<30%，则为球形；（2）如果差异>30%，则为非球形。采用 Fisher 确切检验和 Pearson t 检验进行分析，P<0.05 为差异有统计学意义。
对单一心血管外科手术中心注册中心的回顾性分析显示，球形赘生物患者与非球形赘生物患者相比，出院时存活的几率显著降低（P=0.002）。
对于不适合接受经静脉导线拔除的患者，赘生物大小是影响结局的重要决定因素。然而，赘生物形状也是一个相关因素，与非球形赘生物相比，球形赘生物可能预示着更差的结果。
