Cardiology Department, Centro Hospitalar de Setubal, Setubal, Portugal.
Cardio-Thoracic Department, Centro Hospitalar de Lisboa Ocidental-Hospital de Santa Cruz, Lisboa, Portugal.
Interact Cardiovasc Thorac Surg. 2020 Aug 1;31(2):166-173. doi: 10.1093/icvts/ivaa078.
Our goal was to analyse all lead extraction procedures (transvenous or open surgery) performed in our centre and the short- and long-term follow-up data from these patients.
All lead extractions performed from 2008 to 2017 were retrospectively reviewed for patient characteristics and indications for device implantation; indications for lead extraction; techniques used; peri- and postprocedural complications and short- and long-term follow-up data.
A total of 159 patients (282 leads) were included [age 70 (62-78) years; 72% men]. The median follow-up time was 57 (25-90) months. Patients with lead explants were excluded. The most common indication for lead removal was infection (77%). A surgical approach was necessary in 14 patients (9%) owing to unsuccessful transvenous removal (n = 3), large vegetation in the lead (n = 4), concomitant valvular endocarditis (n = 2), other indications for open surgery (n = 4) and complicated transvenous removal (n = 1). Removal was tried for 282 leads. Of those, 256 were completely removed. Clinical success was achieved in 155 individual patients (98%). Complications occurred in 6 patients: 3 persistent infections, 1 stroke and 2 blood vessel ruptures. The procedure-related mortality rate was 2% (n = 3).
Lead removal was associated with a high success rate and low all-cause complication and mortality rates. Emergency surgery because of acute complications was rare, and open-heart surgery was most frequently elective and not associated with a worse outcome.
分析本中心所有经静脉或开胸的心脏起搏器/除颤器（ICD）导线拔除术的操作过程及患者的短期和长期随访结果。
回顾性分析 2008 年至 2017 年期间所有因心脏起搏器/除颤器相关问题而接受导线拔除术的患者的临床资料，包括患者特征、植入器械的适应证、导线拔除的适应证、使用的技术、围手术期和术后并发症以及短期和长期随访结果。
共纳入 159 例患者（282 根导线）[年龄 70（62-78）岁；72%为男性]。中位随访时间为 57（25-90）个月。排除了接受导线修复的患者。导线拔除的主要适应证是感染（77%）。由于经静脉拔除失败（n=3）、导线内有大的赘生物（n=4）、同期合并瓣膜心内膜炎（n=2）、其他开胸手术适应证（n=4）和经静脉拔除操作复杂（n=1），14 例患者（9%）需要行手术治疗。282 根导线尝试拔除，其中 256 根完全拔除。155 例患者（98%）达到临床成功。6 例患者出现并发症：3 例持续性感染，1 例脑卒中，2 例血管破裂。手术相关死亡率为 2%（n=3）。
心脏起搏器/除颤器导线拔除术成功率高，总体并发症和死亡率低。因急性并发症而紧急手术的情况罕见，开胸手术多为择期手术，且不增加不良预后。
