Kutarski Andrzej, Jacheć Wojciech, Nowosielecka Dorota, Polewczyk Anna
Department of Cardiology, Medical University, 20-059 Lublin, Poland.
2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland.
J Clin Med. 2023 Apr 11;12(8):2811. doi: 10.3390/jcm12082811.
Transvenous lead extraction (TLE) should be completed, even when facing difficulties which have yet to be described. The aim was to explore unexpected TLE obstacles (the circumstances of the occurrence and influence on TLE outcome).
The retrospective analysis of a single centre database containing 3721 TLEs.
Unexpected procedure difficulties (UPDs) occurred in 18.43% of cases (singles in 12.20% of cases and multiples in 6.26% of cases). These included blockages in the lead venous approach in3.28% of cases, functional lead dislodgement in 0.91% of cases, and loss of broken lead fragment in 0.60% of cases. All of them, including implant vein-in 7.98% of cases, lead fracture during extraction-in 3.84% of cases, and lead-to-lead adherence-in 6.59% of cases, Byrd dilator collapse-in 3.41% of cases, including the use of an alternative prolonged the procedure but had no influence on long-term mortality. Most of the occurrences were associated with lead dwell time, younger patient age, lead burden, and poorer procedure effectiveness and complications (common cause). However, some of the problems seemed to be related to cardiac implantable electronic devices (CIED) implantation and the subsequent lead management strategy. A more complete list of all tips and tricks is still required.
(1) The complexity of the lead extraction procedure combines both prolonged procedure duration and the occurrence of lesser-known UPDs. (2) UPDs are present in nearly one fifth of the TLE procedures, and can occur simultaneously. (3) UPDs, which usually force the extractor to expand the range of techniques and tools, should become part of the training in transvenous lead extraction.
即使面临尚未描述的困难，经静脉导线拔除术（TLE）也应完成。目的是探索意外的TLE障碍（发生情况及其对TLE结果的影响）。
对包含3721例TLE的单中心数据库进行回顾性分析。
18.43%的病例出现意外手术困难（UPD）（单个UPD占12.20%的病例，多个UPD占6.26%的病例）。这些包括3.28%的病例中导线静脉入路受阻、0.91%的病例中功能性导线移位以及0.60%的病例中折断导线碎片丢失。所有这些情况，包括7.98%的病例中植入静脉、3.84%的病例中拔除过程中导线断裂以及6.59%的病例中导线与导线粘连、3.41%的病例中伯德扩张器塌陷，包括使用替代方法延长了手术时间，但对长期死亡率没有影响。大多数情况与导线留置时间、患者年龄较轻、导线负荷以及较差的手术效果和并发症（常见原因）有关。然而，一些问题似乎与心脏植入式电子设备（CIED）植入及随后的导线管理策略有关。仍需要更完整的所有技巧和窍门列表。
（1）导线拔除手术的复杂性既包括手术时间延长，也包括出现鲜为人知的UPD。（2）UPD在近五分之一的TLE手术中存在，且可能同时发生。（3）通常迫使拔除者扩大技术和工具范围的UPD，应成为经静脉导线拔除术培训的一部分。
