Azarrafiy Ryan, Carrillo Roger G
University of Miami Miller School of Medicine, Miami, FL, USA.
The Heart Institute at Palmetto General Hospital, Hialeah, FL, USA.
J Innov Card Rhythm Manag. 2019 Feb 15;10(2):3515-3521. doi: 10.19102/icrm.2019.100201. eCollection 2019 Feb.
Cardiac device lead extractions have increased in frequency over the past several years. Although most of these procedures are successfully performed through a percutaneous approach, certain cases may be unmanageable using conventional methods. The traditional approach for such complex cases has been median sternotomy. However, four surgical techniques offer a less-invasive alternative. These include the transatrial approach, the subxiphoid approach, the left minithoracotomy/thoracoscopy, and the ministernotomy. In the present study, we reviewed data from patients who underwent minimally invasive, surgical lead extraction at our institution from January 2003 to October 2017 using an ongoing, prospective registry. Summary statistics were generated for age, sex, device extracted, lead dwell time (years), procedure indication, major/minor complications and procedural success as defined by the 2017 Heart Rhythm Society consensus statement, and survival at discharge. Between January 2003 and October 2017, 14 cases at our center were managed via a transatrial approach, whereas 11 involved the subxiphoid approach, 19 involved a left minithoracotomy or thoracoscopy, and one involved a ministernotomy. For the transatrial approach, all cases were classified as procedural successes and all patients were discharged alive. Additionally, for the subxiphoid approach, all cases were deemed procedural successes, whereas survival at discharge was 90.9%. For the left minithoracotomy/thoracoscopy, all cases were procedural successes and survival at discharge was 94.7%. Lastly, the ministernotomy was successfully used to remove an infected, retained lead fragment from the innominate vein. In conclusion, at our institution, the transatrial approach, the subxiphoid approach, the left minithoracotomy/thoracoscopy, and the ministernotomy were used as minimally invasive, surgical approaches that represent fairly safe and effective alternatives to median sternotomy in complex cases unamenable to management via conventional, percutaneous approaches to lead extraction.
在过去几年中，心脏设备导线拔除的频率有所增加。尽管这些手术大多通过经皮途径成功完成，但某些病例使用传统方法可能难以处理。对于此类复杂病例，传统方法是正中胸骨切开术。然而，有四种手术技术提供了侵入性较小的替代方法。这些方法包括经心房途径、剑突下途径、左前胸小切口/胸腔镜检查和胸骨旁小切口。在本研究中，我们回顾了2003年1月至2017年10月在我们机构接受微创外科导线拔除的患者数据，这些数据来自一个正在进行的前瞻性登记处。根据2017年心律学会共识声明，生成了年龄、性别、拔除的设备、导线留置时间（年）、手术指征、主要/次要并发症、手术成功率以及出院生存率的汇总统计数据。2003年1月至2017年10月期间，我们中心有14例通过经心房途径处理，11例采用剑突下途径，19例采用左前胸小切口或胸腔镜检查，1例采用胸骨旁小切口。对于经心房途径，所有病例均被归类为手术成功，所有患者均存活出院。此外，对于剑突下途径，所有病例均被视为手术成功，而出院生存率为90.9%。对于左前胸小切口/胸腔镜检查，所有病例均手术成功，出院生存率为94.7%。最后，胸骨旁小切口成功用于从无名静脉取出感染的、残留的导线碎片。总之在我们机构，经心房途径剑突下途径、左前胸小切口/胸腔镜检查和胸骨旁小切口被用作微创外科手术方法，对于无法通过传统经皮导线拔除方法处理的复杂病例，这些方法是正中胸骨切开术相当安全有效的替代方法。
