Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Hospital Eppendorf, Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
J Cardiovasc Electrophysiol. 2023 Sep;34(9):1951-1960. doi: 10.1111/jce.16018. Epub 2023 Jul 26.
In an aging population with cardiac implantable electronic devices, an increasing number of octo- and even nonagenarians present for lead extraction procedures. Those patients are considered at increased risk for surgical procedures including lead extraction. Here, we investigated safety and efficacy of transvenous lead extraction in a large patient cohort of octo- and nonagenarians.
A subgroup analysis of all patients aged ≥80 years (n = 499) in the German Laser Lead Extraction Registry (GALLERY) was performed. Outcomes were compared to the nonoctogenarians from the registry. Primary extraction method was Laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. An analysis of patient- and device characteristics, as well as an assessment of predictors for adverse events via multivariate analyses was conducted. Mean patients age was 84.3 ± 3.7 years in the octogenarians group and 64.1 ± 12.4 years in the nonoctogenarians group. The median lead dwell time was 118.0 months (78; 167) and 92.0 months [60; 133], p < .001 in the octogenarians and nonoctogenarians group, respectively. Clinical procedural success rate was achieved in 97.6% of the cases in octogenarians and 97.9% in nonoctogenarians (p = .70). Overall complication rate was 4.4% in octogenarians and 4.3% in nonoctogenarians (0.91). In octogenarians procedure-related mortality was 0.8% and all-cause in-hospital mortality was 5.4%, while in nonoctogenarians, procedure related and all-cause in-hospital mortality were 0.5% and 3.1%, respectively. A body mass index (BMI) <20 kg/m , was the only statistically significant predictor for procedure-related complications in octogenarians, while systemic infection, BMI ≤20 kg/m , procedural complications and chronic kidney disease were predictors for in-hospital mortality.
Laser lead extraction in octo- and nonagenarians is safe and effective. BMI ≤20 kg/m was the only statistically significant predictor for procedural complications. According to our data, advanced age should not be considered as contraindication for laser lead extraction.
在人口老龄化且拥有心脏植入式电子设备的情况下，越来越多的 80 岁以上甚至 90 岁以上的患者需要进行导线拔除手术。这些患者在接受手术包括导线拔除术时被认为存在更高的风险。在此，我们对 80 岁以上的大型患者队列（n=499）进行了经静脉导线拔除术的安全性和有效性研究。
对德国激光导线拔除登记处（GALLERY）中所有年龄≥80 岁的患者（n=499）进行了亚组分析。将结果与登记处的非 80 岁以上患者进行比较。主要的拔除方法是激光导线拔除术，如果需要，还可使用机械旋转护套或股静脉套索。进行了患者和设备特征的分析，并通过多变量分析评估了不良事件的预测因素。80 岁以上组患者的平均年龄为 84.3±3.7 岁，而非 80 岁以上组为 64.1±12.4 岁。80 岁以上组和非 80 岁以上组的中位导线留置时间分别为 118.0 个月（78；167）和 92.0 个月[60；133]，p<0.001。80 岁以上组和非 80 岁以上组的临床手术成功率分别为 97.6%和 97.9%（p=0.70）。80 岁以上组的总并发症发生率为 4.4%，非 80 岁以上组为 4.3%（0.91）。80 岁以上组的手术相关死亡率为 0.8%，全因住院死亡率为 5.4%，而非 80 岁以上组的手术相关和全因住院死亡率分别为 0.5%和 3.1%。体重指数（BMI）<20kg/m²是 80 岁以上患者手术相关并发症的唯一有统计学意义的预测因素，而全身感染、BMI≤20kg/m²、手术并发症和慢性肾病是住院死亡率的预测因素。
80 岁以上和 90 岁以上患者的激光导线拔除术是安全有效的。BMI≤20kg/m²是手术相关并发症的唯一有统计学意义的预测因素。根据我们的数据，高龄不应被视为激光导线拔除术的禁忌症。
