Cao Zhongming, Xu Jindong, Liu Jian, Wu Min, Xie Nianjin, Guo Xiaogang, Guo Huiming, Wang Sheng
Department of Anesthesiology, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Anesthesiology, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China.
Ann Transl Med. 2020 Oct;8(19):1227. doi: 10.21037/atm-20-5817.
Fluoroscopic guidance is the traditional method for the implantation of transvenous temporary cardiac pacemakers (TVTPs). This study aimed to compare the time, effectiveness, and safety of real-time three-dimensional transesophageal echocardiography (3D TEE) with those of fluoroscopy in guiding TVTP implantation.
The records of patients who underwent transcatheter aortic valve implantation (TAVI) guided by real-time 3D TEE or fluoroscopy between July 1, 2016, and June 30, 2020, were retrospectively analyzed. TVTPs were implanted by anesthesiologists via the right internal jugular vein (IJV) in the real-time 3D TEE-guided group (3D TEE group), and by interventional cardiologists via the femoral vein in the fluoroscopy-guided group (fluoro group).
A total of 143 patients (3D TEE-group n=79, and fluoro group n=64) were included. No statistical differences were observed in the baseline characteristics of the two groups. TVTPs were successfully implanted in all of the patients. The needle-to-pace time was significantly shorter in 3D TEE group than in fluoro group (5.2±2.9 8.5±4.6 min, P<0.001). Further, the incidence of access complications was significantly lower in 3D TEE group than in fluoro group (3.8% 12.5%, P<0.05). One patient in fluoro group who suffered cardiac perforation underwent drainage via pericardiocentesis. No patients in either group died because of TVTP placement. The total complication rates were significantly lower in 3D TEE group than in fluoro group (19.0% 39.1%, P<0.05). No statistically significant differences existed between groups in terms of pacing threshold, the incidence of permanent pacemaker insertion after surgery, the length of postoperative intensive care unit (ICU) stay, or the duration of postoperative hospitalization.
Real-time 3D TEE-guided can be used to effectively, quickly, and safely guide TVTP implantation. The procedure can be performed by properly trained anesthesiologists. Therefore, real-time 3D TEE is a suitable option for guiding perioperative TVTP implantation in patients undergoing cardiac surgery.
透视引导是经静脉临时心脏起搏器（TVTP）植入的传统方法。本研究旨在比较实时三维经食管超声心动图（3D TEE）与透视在引导TVTP植入方面的时间、有效性和安全性。
回顾性分析2016年7月1日至2020年6月30日期间在实时3D TEE或透视引导下接受经导管主动脉瓣植入术（TAVI）的患者记录。在实时3D TEE引导组（3D TEE组）中，麻醉医生经右颈内静脉（IJV）植入TVTP，在透视引导组（透视组）中，介入心脏病专家经股静脉植入TVTP。
共纳入143例患者（3D TEE组n = 79，透视组n = 64）。两组的基线特征无统计学差异。所有患者均成功植入TVTP。3D TEE组的穿刺至起搏时间显著短于透视组（5.2±2.9对8.5±4.6分钟，P < 0.001）。此外，3D TEE组的穿刺并发症发生率显著低于透视组（3.8%对12.5%，P < 0.05）。透视组1例发生心脏穿孔的患者经心包穿刺引流。两组均无患者因TVTP植入死亡。3D TEE组的总并发症发生率显著低于透视组（19.0%对39.1%，P < 0.05）。两组在起搏阈值、术后永久起搏器植入发生率、术后重症监护病房（ICU）住院时间或术后住院时间方面无统计学显著差异。
实时3D TEE引导可有效、快速且安全地引导TVTP植入。该操作可由经过适当培训的麻醉医生进行。因此，实时3D TEE是指导心脏手术患者围手术期TVTP植入的合适选择。
