Hahnel Fabian, Pecha Simon, Bernhardt Alexander, Barten Markus J, Chung Da-Un, Sinning Christoph, Willems Stephan, Reichenspurner Hermann, Hakmi Samer
Department of Trauma Surgery and Orthopedics, Asklepios Clinic Wandsbek, Hamburg, Germany.
Department of Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany.
J Cardiovasc Electrophysiol. 2020 Apr;31(4):854-859. doi: 10.1111/jce.14393. Epub 2020 Feb 24.
Many patients awaiting heart transplantation (HTX) have a cardiac implantable electronic device (CIED). Lead removal is often still a part of the HTX procedure. Abandoned lead fragments carry a risk for infections and prohibit magnetic resonance imaging (MRI) imaging. This study evaluated the concept of an elective lead management algorithm after HTX.
Between 2009 and 2018, 102 consecutive patients with previously implanted CIED underwent HTX. Lead removal by manual traction during HTX was performed in 74 patients until December 2014. Afterward, treatment strategy was changed and 28 patients received elective lead extraction procedures in a hybrid operating room (OR) using specialized extraction tools. Total of 74 patients with 157 leads underwent lead extraction by manual traction during HTX. The mean lead age was 32.3 ± 38.7 months. Postoperative X-ray revealed abandoned intravascular lead fragments in 31(41.9%) patients, resulting in a complete lead extraction rate of only 58.1%. The high rate of unsuccessful lead extractions led to the change in the extraction strategy in 2015. Since then, HTX was performed in 28 CIED patients. In those patients, 64 leads with a mean lead age of 53.8 ± 42.8 months were treated in an elective lead extraction procedure. No major or minor complications occurred during lead extraction. All leads could be removed completely, resulting in a procedural success rate of 100%.
Our results demonstrate that chronically implanted leads should be removed in an elective procedure, using appropriate extraction tools. This enables complete lead extraction, which reduces the infection risk in this patient population with the necessity for permanent immunosuppressive therapy and allows further MRI surveillance.
许多等待心脏移植（HTX）的患者都有心脏植入式电子设备（CIED）。导线移除通常仍是HTX手术的一部分。废弃的导线碎片存在感染风险，并禁止进行磁共振成像（MRI）检查。本研究评估了HTX术后选择性导线管理算法的概念。
2009年至2018年期间，102例先前植入CIED的患者连续接受了HTX手术。2014年12月前，74例患者在HTX手术期间通过手动牵引进行导线移除。此后，治疗策略发生改变，28例患者在杂交手术室（OR）使用专门的提取工具接受了选择性导线提取手术。共有74例患者的157根导线在HTX手术期间通过手动牵引进行了导线提取。导线的平均使用年限为32.3±38.7个月。术后X线检查显示，31例（41.9%）患者存在废弃的血管内导线碎片，导致完全导线提取率仅为58.1%。高失败率的导线提取导致2015年提取策略发生改变。从那时起，28例CIED患者接受了HTX手术。在这些患者中，64根平均使用年限为53.8±42.8个月的导线在选择性导线提取手术中得到治疗。导线提取过程中未发生任何大或小的并发症。所有导线均能完全移除，手术成功率为100%。
我们的结果表明，应使用适当的提取工具，在择期手术中移除长期植入的导线。这能够实现完全的导线提取，降低了该需要长期免疫抑制治疗的患者群体的感染风险，并允许进一步的MRI监测。
