Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamość, 22-400 Zamość, Poland.
Department of Physiology Pathophysiology and Clinical Immunology, Collegium Medicum, The Jan Kochanowski University, 25-317 Kielce, Poland.
Int J Environ Res Public Health. 2021 Oct 3;18(19):10416. doi: 10.3390/ijerph181910416.
Transvenous lead extraction (TLE) is the preferred management strategy for complications related to cardiac implantable electronic devices. TLE sometimes can cause serious complications. Outcomes of TLE procedures using non-powered mechanical sheaths were analyzed in 1500 patients (mean age 68.11 years; 39.86% females) admitted to two high-volume centers. Complete procedural success was achieved in 96.13% of patients; clinical success in 98.93%, no periprocedural death occurred. Mean lead dwell time in the study population was 112.1 months. Minor complications developed in 115 (7.65%), major complications in 33 (2.20%) patients. The most frequent minor complications were tricuspid valve damage (TVD) (3.20%) and pericardial effusion that did not necessitate immediate intervention (1.33%). The most common major complication was cardiac laceration/vascular tear (1.40%) followed by an increase in TVD by two or three grades to grade 4 (0.80%). Despite the long implant duration (112.1 months) satisfying results without procedure-related death can be obtained using mechanical tools. Lead remnants or severe tricuspid regurgitation was the principal cause of lack of clinical and procedural success. Worsening TR(Tricuspid regurgitation) (due to its long-term consequences), but not cardiac/vascular wall damage; is still the biggest TLE-related problem; when non-powered mechanical sheaths are used as first-line tools.
经静脉心脏植入电子设备导线拔除术（TLE）是治疗心脏植入电子设备相关并发症的首选方法。TLE 有时会导致严重的并发症。在两个大容量中心收治的 1500 例患者（平均年龄 68.11 岁；女性占 39.86%）中，分析了使用非动力机械护套进行 TLE 手术的结果。96.13%的患者达到了完全手术成功；98.93%的患者达到了临床成功，无围手术期死亡。研究人群中平均导线留置时间为 112.1 个月。115 例（7.65%）发生轻微并发症，33 例（2.20%）发生严重并发症。最常见的轻微并发症是三尖瓣损伤（TVD）（3.20%）和心包积液，无需立即干预（1.33%）。最常见的严重并发症是心脏撕裂/血管撕裂（1.40%），其次是 TVD 增加两个或三个等级至 4 级（0.80%）。尽管植入时间较长（112.1 个月），但使用机械工具可以获得无手术相关死亡的满意结果。导线残留或严重三尖瓣反流是导致临床和手术失败的主要原因。TR（三尖瓣反流）恶化（由于其长期后果），而不是心脏/血管壁损伤，仍然是使用非动力机械护套作为一线工具时与 TLE 相关的最大问题。
