Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary.
Heart Surgery Department, University of Szeged, Semmelweis str. 8, 6725 Szeged, Hungary.
Europace. 2023 Feb 16;25(2):591-599. doi: 10.1093/europace/euac200.
During transvenous lead extraction (TLE) longer dwelling time often requires the use of powered sheaths. This study aimed to compare outcomes with the laser and powered mechanical tools.
Single-centre data from consecutive patients undergoing TLE between 2012 and 2021 were retrospectively analysed. Efficacy and safety of the primary extraction tool were compared. Procedures requiring crossover between powered sheaths were also analysed. Moreover, we examined the efficacy of each level of the stepwise approach. Out of 166 patients, 142 (age 65.4 ± 13.7 years) underwent TLE requiring advanced techniques with 245 leads (dwelling time 9.4 ± 6.3 years). Laser sheaths were used in 64.9%, powered mechanical sheaths in 35.1% of the procedures as primary extraction tools. Procedural success rate was 85.5% with laser and 82.5% with mechanical sheaths (P = 0.552). Minor and major complications were observed in similar rate. Procedural mortality occurred only in the laser group in the case of three patients. Crossover was needed in 19.5% after laser and in 12.8% after mechanical extractions (P = 0.187). Among crossover procedures, only clinical success favoured the secondary mechanical arm (87.1 vs. 54.5%, aOR: 0.09, 95% CI: 0.01-0.79, P = 0.030). After step-by-step efficacy analysis, procedural success was 64.9% with the first-line extraction tool, 75.1% after crossover, 84.5% with bailout femoral snare, and 91.8% by non-emergency surgery.
The efficacy and safety of laser and mechanical sheaths were similar, however in the subgroup of crossover procedures mechanical tools had better performance regarding clinical success. Device diversity seems to help improving outcomes, especially in the most complicated cases.
在经静脉导线拔除术（TLE）中，较长的留置时间通常需要使用动力鞘管。本研究旨在比较激光和动力机械工具的结果。
回顾性分析了 2012 年至 2021 年期间连续接受 TLE 的单中心患者数据。比较了主要拔除工具的疗效和安全性。还分析了需要在动力鞘管之间转换的程序。此外，我们检查了逐步方法每个级别（level）的疗效。在 166 例患者中，142 例（年龄 65.4±13.7 岁）因需要高级技术而接受 TLE，共拔除 245 根导线（留置时间 9.4±6.3 年）。激光鞘管在 64.9%的手术中，动力机械鞘管在 35.1%的手术中作为主要拔除工具。激光组和机械组的手术成功率分别为 85.5%和 82.5%（P=0.552）。两种方法均出现轻微和严重并发症。只有激光组的 3 例患者发生手术相关死亡。激光组和机械组的转换率分别为 19.5%和 12.8%（P=0.187）。在转换手术中，只有临床成功率支持二线机械臂（87.1%比 54.5%，优势比：0.09，95%置信区间：0.01-0.79，P=0.030）。在逐步疗效分析后，一线拔除工具的手术成功率为 64.9%，转换后的手术成功率为 75.1%， bailout 股动脉套圈的手术成功率为 84.5%，非紧急手术的手术成功率为 91.8%。
激光和机械鞘管的疗效和安全性相似，但在转换手术的亚组中，机械工具在临床成功率方面表现更好。器械多样性似乎有助于提高结果，特别是在最复杂的情况下。
