Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
Eur J Cardiothorac Surg. 2022 Jul 11;62(2). doi: 10.1093/ejcts/ezac318.
Manipulation of the heart during cardiac surgery in patients with cardiac implantable electronic devices (CIEDs) may result in lead damage or displacement, but whether cardiac surgery truly infers an excess risk of lead failure is not known. The objective of this study was to examine the risk of lead complications after cardiac surgery in patients with CIEDs.
We conducted a nationwide nested case-control study. The source population comprised all Danish patients ≥18 of age who underwent a de novo CIED implantation during 1998-2017. For inclusion, patients had to be alive and event free 6 months after implantation. Cases were matched 1:30 to controls on time, age, sex, and device type using risk set sampling. We used conditional logistic regression to estimate incidence rate ratios (IRRs) for the association between cardiac surgery and lead-related reoperation.
Our final population consisted of 67 621 patients. We identified 1437 (2.1%) incident cases of lead-related reoperations and 42 698 controls. Risk of lead complications was highest within 6 months of cardiac surgery [IRR 9.7, 95% confidence interval (CI) 6.3-14.8, adjusted IRR 9.6, 95% CI 6.2-14.7], and at 1 year, the relative risk of lead-related reoperation was close to unity (adjusted IRR 1.2, 95% CI 0.8-1.7).
Cardiac surgery was associated with a considerable risk of lead complications in patients with de novo CIEDs.
在心脏手术中对心脏进行操作可能会导致心脏植入式电子设备（CIED）的导联损坏或移位，但心脏手术是否确实会增加导联故障的风险尚不清楚。本研究的目的是检查心脏手术后 CIED 患者的导联并发症风险。
我们进行了一项全国性的巢式病例对照研究。研究人群包括所有在 1998 年至 2017 年间接受新植入 CIED 的丹麦≥18 岁患者。为了纳入研究，患者必须在植入后 6 个月时仍然存活且无事件发生。使用风险集抽样，通过时间、年龄、性别和设备类型对病例和对照进行 1:30 匹配。我们使用条件逻辑回归估计心脏手术与导联相关再手术之间的关联的发病率比（IRR）。
我们的最终人群包括 67621 名患者。我们确定了 1437 例（2.1%）与导联相关的再手术事件和 42698 例对照。心脏手术后 6 个月内发生导联并发症的风险最高[IRR 9.7，95%置信区间（CI）6.3-14.8，调整后的 IRR 9.6，95% CI 6.2-14.7]，而在 1 年内，与导联相关的再手术的相对风险接近 1（调整后的 IRR 1.2，95% CI 0.8-1.7）。
在接受新植入 CIED 的患者中，心脏手术与导联并发症的风险显著相关。
