Division of Cardiovascular Medicine, Arrhythmia Section, Vanderbilt University Medical Center, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee.
J Cardiovasc Electrophysiol. 2020 Mar;31(3):718-722. doi: 10.1111/jce.14363. Epub 2020 Jan 30.
The optimal approach to the extraction of leads with large vegetations remains uncertain.
High-risk patients with lead associated vegetations undergoing device extraction at Vanderbilt Hospital with concomitant use of the Penumbra Aspiration System (Penumbra Inc, Alameda, CA) are described. An 8.5 Fr Agilis NXT (Abbott Inc, St. Paul, MN) was advanced to the right atrium, through which a Penumbra Indigo Cat-8 catheter was advanced. Using intracardiac echocardiography, the Penumbra was positioned directly on the vegetation, suction was applied until adherent, and the Indigo catheter and Agilis sheath were then removed en-bloc and aspirated debris flushed out. This was repeated until debulking was considered successful.
Eight cases were performed. The median vegetation size was 2 cm. Pathogens were Enterococcus, Staphylococcus, Candida, Cutibacterium, and Enterobacter. In seven of eight cases, aspiration successfully reduced vegetations to less than 1 cm before successful percutaneous cardiac implantable electronic device removal. One patient underwent surgical removal via thoracotomy. There were no acute complications related to the Penumbra catheter. Three patients had CT evidence of small pulmonary emboli postprocedure. The length of stay was 3 to 27 days. One patient died on POD 1 of refractory ventricular tachycardia unrelated to the procedure. One patient died of ongoing sepsis 2 weeks postextraction.
The Penumbra Indigo Aspiration system can be useful for vegetation debulking before transvenous lead extraction.
对于带大赘生物的导联的最佳提取方法仍不确定。
描述了在范德比尔特医院进行器械提取的伴有大赘生物的高危患者，同时使用了 Penumbra 抽吸系统（Penumbra Inc，加利福尼亚州阿拉米达）。将 8.5Fr Agilis NXT（雅培公司，明尼苏达州圣保罗）推进右心房，通过该通道推进 Penumbra Indigo Cat-8 导管。使用心内超声心动图，将 Penumbra 直接放置在赘生物上，施加吸力直到附着，然后将 Indigo 导管和 Agilis 护套一起取出并抽吸冲洗出碎片。重复此操作，直到认为减容成功。
进行了 8 例。中位数赘生物大小为 2cm。病原体为肠球菌、葡萄球菌、念珠菌、棒状杆菌和肠杆菌。在 8 例中的 7 例中，抽吸成功地将赘生物减小到 1cm 以下，然后成功地移除了经皮心脏植入式电子设备。1 例患者通过开胸手术切除。Penumbra 导管无急性并发症。3 例患者术后 CT 显示有小的肺栓塞。住院时间为 3 至 27 天。1 例患者因与手术无关的难治性室性心动过速在术后第 1 天死亡。1 例患者在提取后 2 周死于持续败血症。
Penumbra Indigo 抽吸系统可用于经静脉导联提取前的赘生物减容。
