Misra Satish, Swayampakala Kamala, Coons Patricia, Cerbie Claire, Guifarro Angello, Lesiczka Magdalena, Holshouser John W, Madjarov Jeko, Love Charles, Mehta Rohit
Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA.
Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
J Cardiovasc Electrophysiol. 2021 Jul;32(7):1969-1978. doi: 10.1111/jce.15105. Epub 2021 Jun 1.
Transvenous lead extraction (TLE) is an important part of comprehensive lead management. The selection of tools available has expanded in recent years but data on their efficacy is limited.
To evaluate outcomes using the TightRail™ mechanical rotating mechanical dilator sheath in comparison to excimer laser sheaths and describe factors predictive of successful extraction.
Patients undergoing TLE at a single tertiary center (2013-2019) were included in a prospective registry. Leads targeted for extraction with either an SLS II/Glidelight™ or TightRail™ sheath were included. Outcomes were analyzed on a per-lead basis. Generalized estimating equation (GEE) models were used to assess differences in lead extraction success by extraction tool used while adjusting for nonindependence of multiple leads extracted from the same patient. Covariates included patient comorbidities, lead characteristics, and sheath size.
A total of 575 leads extracted from 372 patients were included. Overall success rate was 97%. TightRail™ was the first tool used in 180 (31.3%) leads with success rate of 61.7%; laser sheaths were the first tool in 395 leads (68.7%) with success rate of 67.8%. Predictors of successful extraction included lead age, lead type, and sheath sizing. Extraction success did not differ based on whether a laser or TightRail™ sheath was used (adjusted odds ratio = 0.94; 95% confidence interval = 0.59-1.50).
The TightRail™ sheath is an effective tool for TLE. Lead age, lead type, and sheath sizing were predictive of successful extraction but sheath type was not. These findings are hypothesis generating and warrant further investigation in a prospective, randomized study.
经静脉导线拔除术（TLE）是综合导线管理的重要组成部分。近年来，可用工具的选择有所增加，但关于其疗效的数据有限。
与准分子激光鞘相比，评估使用TightRail™机械旋转扩张鞘的效果，并描述成功拔除的预测因素。
在一个单一的三级中心（2013 - 2019年）接受TLE的患者被纳入前瞻性登记研究。纳入使用SLS II/Glidelight™或TightRail™鞘进行拔除的导线。按每根导线分析结果。使用广义估计方程（GEE）模型评估使用不同拔除工具时导线拔除成功率的差异，同时调整从同一患者拔除多根导线的非独立性。协变量包括患者合并症、导线特征和鞘的尺寸。
共纳入从372例患者中拔除的575根导线。总体成功率为9７%。TightRail™是180根（31.3%）导线中首先使用的工具，成功率为61.7%；激光鞘是395根导线（68.7%）中首先使用的工具，成功率为67.8%。成功拔除的预测因素包括导线使用年限、导线类型和鞘的尺寸。无论使用激光鞘还是TightRail™鞘，拔除成功率无差异（调整后的优势比 = 0.94；95%置信区间 = 0.59 - 1.50）。
TightRail™鞘是TLE的有效工具。导线使用年限、导线类型和鞘的尺寸可预测成功拔除，但鞘的类型不能。这些发现仅为提出假设，需要在前瞻性随机研究中进一步探究。
