Kosior Jarosław, Jacheć Wojciech, Polewczyk Anna, Karpeta Kamil, Cholewiński Paweł, Czajkowski Marek, Kutarski Andrzej
Department of Cardiology, Masovian Specialistic Hospital of Radom, Radom, Poland.
2nd Department of Cardiology, Zabrze, Faculty of Medical Science in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland.
Kardiol Pol. 2023;81(3):242-251. doi: 10.33963/KP.a2022.0266. Epub 2022 Nov 29.
Transvenous lead extraction (TLE) procedures are now increasingly safe, but there is still a risk of major complications (MC).
We aimed to assess the impact of TLE organization on the safety of procedures.
We analyzed 2216 TLE procedures performed in two centers in the years 2006-2021 and compared three organizational procedural models: (1) TLE in an electrophysiology laboratory (EP-LAB) with intravenous analgesia/sedation; (2) TLE with grading of safety requirements (high-risk patients in the cardiac surgery operating theatre, others in EP-LAB); (3) TLE in the hybrid room in all patients under general anesthesia with transesophageal echocardiographic (TEE) monitoring. The safety of procedures and mortality after TLE in three-year follow-up were assessed.
The rate of MC in the EP-LAB group was 1.55%, and the rate of procedure-related deaths (PRD) was 0.33%. While using the graded approach to safety requirements, the percentage of MC was 2.61% and PRD 0.29%. When performing TLE procedures in the hybrid room, the MC percentage was 1.33% and PRD 0.00%. Long-term survival after TLE was comparable in all study groups.
A key factor in preventing TLE-related deaths is procedure organization that enables emergency cardiac surgery. TLE performed in a hybrid room with a collaborating cardiac surgeon and vital signs monitoring appears to be the safest possible option for the patient. A graded safety approach is associated with the risk of unexpected MC and PRD. Any newly established TLE center can achieve satisfactory results if the optimal organizational model of the procedure is used.
经静脉导线拔除（TLE）手术目前越来越安全，但仍存在发生严重并发症（MC）的风险。
我们旨在评估TLE手术组织方式对手术安全性的影响。
我们分析了2006年至2021年在两个中心进行的2216例TLE手术，并比较了三种组织手术模式：（1）在电生理实验室（EP-LAB）进行的TLE手术，采用静脉镇痛/镇静；（2）根据安全要求分级进行的TLE手术（心脏外科手术室的高危患者，其他患者在EP-LAB）；（3）在杂交手术室对所有患者进行全身麻醉并经食管超声心动图（TEE）监测下的TLE手术。评估了手术安全性及TLE术后三年随访的死亡率。
EP-LAB组的MC发生率为1.55%，与手术相关的死亡率（PRD）为0.33%。采用安全要求分级方法时，MC的百分比为2.61%，PRD为0.29%。在杂交手术室进行TLE手术时，MC百分比为1.33%，PRD为0.00%。所有研究组TLE术后的长期生存率相当。
预防与TLE相关死亡的关键因素是能够进行紧急心脏手术的手术组织方式。在杂交手术室由心脏外科医生协作并进行生命体征监测下进行的TLE手术似乎是对患者最安全的选择。安全分级方法与意外MC和PRD的风险相关。如果采用最佳的手术组织模式，任何新成立的TLE中心都能取得满意的结果。
