Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Cardiac Surgery Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
Pacing Clin Electrophysiol. 2021 May;44(5):895-902. doi: 10.1111/pace.14206. Epub 2021 Mar 27.
There are limited data on the comparative analyses of TightRail rotating dilator sheath (Philips) and laser sheath for lead extraction.
To evaluate the effectiveness and safety of the TightRail sheath as a primary or secondary tool for transvenous lead extraction (TLE).
Retrospective cohort analysis of 202 consecutive patients who underwent TLE using either TightRail sheath and/or GlideLight laser sheath (Philips) in our hospital. The study population was divided into three groups: Group A underwent TLE with laser sheath only (N = 157), Group B with TightRail sheath only (N = 22), and Group C with both sheaths (N = 23).
During this period, 375 leads in 202 patients were extracted, including 297 leads extracted by laser sheath alone, 45 leads by TightRail sheath alone, and 33 by both TightRail sheath and laser sheaths. The most common indications included device infection (44.6%) and lead-related complications (44.1%). The median age of leads was 8.9 years. TightRail sheath (Group B) achieved similar efficacy as a primary extraction tool compared with laser sheath (Group A), with complete procedure success rate of 93.3% (vs. 96.6%, P = .263) and clinical success rate of 100.0% (vs. 98.1%, P = .513). Among 32 leads in which Tightrail was used after laser had failed (Group C), the complete procedure success rate was 75.8%. No significant difference in procedural adverse events was observed.
Our single-center experience confirms that the TightRail system is an effective first-line and second-line method for TLE. Further investigation is required to guide the selection of mechanical and laser sheaths in lead extraction cases.
关于经静脉心脏起搏器导线拔除中 TightRail 旋转扩张鞘（飞利浦）与激光鞘的对比分析数据有限。
评估 TightRail 鞘作为经静脉心脏起搏器导线拔除术（TLE）的一线或二线工具的有效性和安全性。
回顾性分析了 202 例连续患者，他们在我院使用 TightRail 鞘和/或 GlideLight 激光鞘（飞利浦）进行 TLE。研究人群分为三组：A 组仅使用激光鞘（N=157），B 组仅使用 TightRail 鞘（N=22），C 组同时使用两种鞘（N=23）。
在此期间，202 例患者 375 根导线接受了拔除，其中 297 根导线单独使用激光鞘拔除，45 根导线单独使用 TightRail 鞘拔除，33 根导线同时使用两种鞘拔除。最常见的适应证包括器械感染（44.6%）和导线相关并发症（44.1%）。导线的中位年龄为 8.9 岁。TightRail 鞘（B 组）作为一线拔除工具与激光鞘（A 组）具有相似的疗效，其完全手术成功率为 93.3%（96.6%，P=0.263），临床成功率为 100.0%（98.1%，P=0.513）。在激光失败后使用 Tightrail 的 32 根导线上（C 组），完全手术成功率为 75.8%。未观察到手术不良事件的显著差异。
我们的单中心经验证实，TightRail 系统是 TLE 的一种有效一线和二线方法。需要进一步的研究来指导在导线拔除病例中选择机械鞘和激光鞘。
