Kloppe Axel, Fischer Julian, Aweimer Assem, Schöne Dominik, El-Battrawy Ibrahim, Hanefeld Christoph, Mügge Andreas, Schiedat Fabian
Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany.
Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany.
J Clin Med. 2023 Dec 11;12(24):7613. doi: 10.3390/jcm12247613.
Infection, lead dysfunction and system upgrades are all reasons that transvenous lead extraction is being performed more frequently. Many centres focus on a single method for lead extraction, which can lead to either lower success rates or higher rates of major complications. We report our experience with a systematic approach from a less invasive to a more invasive strategy without the use of laser sheaths.
Consecutive extraction procedures performed over a period of seven years in our electrophysiology laboratory were included. We performed a stepwise approach with careful traction, lead locking stylets (LLD), mechanical non-powered dilator sheaths, mechanical powered sheaths and, if needed, femoral snares.
In 463 patients (age 69.9 ± 12.3, 31.3% female) a total of 780 leads (244 ICD leads) with a mean lead dwelling time of 5.4 ± 4.9 years were identified for extraction. Success rates for simple traction, LLD, mechanical non-powered sheaths and mechanical powered sheaths were 31.5%, 42.7%, 84.1% and 92.6%, respectively. A snare was used for 40 cases (as the primary approach for 38 as the lead structure was not intact and stepwise approach was not feasible) and was successful for 36 leads (90.0% success rate). Total success rate was 93.1%, clinical success rate was 94.1%. Rate for procedural failure was 1.1%. Success for less invasive steps and overall success for extraction was associated with shorter lead dwelling time ( < 0.001). Major procedure associated complications occurred in two patients (0.4%), including one death (0.2%). A total of 36 minor procedure-associated complications occurred in 30 patients (6.5%). Pocket hematoma correlated significantly with uninterrupted dual antiplatelet therapy ( = 0.001). Pericardial effusion without need for intervention was associated with long lead dwelling time ( = 0.01) and uninterrupted acetylsalicylic acid ( < 0.05).
A stepwise approach with a progressive invasive strategy is effective and safe for transvenous lead extraction.
感染、导线功能障碍和系统升级都是经静脉导线拔除术更频繁开展的原因。许多中心专注于单一的导线拔除方法，这可能导致成功率较低或主要并发症发生率较高。我们报告了我们采用一种从侵入性较小到侵入性较大的系统方法（不使用激光鞘）的经验。
纳入了在我们的电生理实验室七年间连续进行的拔除手术。我们采用逐步方法，包括仔细牵引、导线锁定探条（LLD）、机械非动力扩张鞘、机械动力鞘，如有需要还使用股静脉圈套器。
在463例患者（年龄69.9±12.3岁，女性占31.3%）中，共确定了780根导线（244根植入式心律转复除颤器导线）需要拔除，导线平均植入时间为5.4±4.9年。单纯牵引、LLD、机械非动力鞘和机械动力鞘的成功率分别为31.5%、42.7%、84.1%和92.6%。40例使用了圈套器（38例作为主要方法，因为导线结构不完整且逐步方法不可行），36根导线成功（成功率90.0%）。总成功率为93.1%，临床成功率为94.1%。手术失败率为1.1%。侵入性较小步骤的成功和拔除的总体成功与较短的导线植入时间相关（<0.001）。两名患者（0.4%）发生了主要手术相关并发症，包括一例死亡（0.2%）。30例患者（6.5%）共发生36例轻微手术相关并发症。囊袋血肿与不间断双联抗血小板治疗显著相关（=0.001）。无需干预的心包积液与较长的导线植入时间相关（=0.01）和不间断使用阿司匹林相关（<0.05）。
采用逐步推进的侵入性策略的方法对于经静脉导线拔除术是有效且安全的。
