Nowosielecka Dorota, Jacheć Wojciech, Stefańczyk Dzida Małgorzata, Polewczyk Anna, Mościcka Dominika, Nowosielecka Agnieszka, Kutarski Andrzej
Department of Cardiac Surgery, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland.
Department of Cardiology, The Pope John Paul II Province Hospital, 22-400 Zamość, Poland.
J Clin Med. 2024 Sep 5;13(17):5278. doi: 10.3390/jcm13175278.
Transesophageal echocardiography (TEE) is mandatory before transvenous lead extraction (TLE), but its usefulness remains underestimated. This study aims to describe the broad range of TEE findings in TLE candidates, as well as their influence on procedure complexity, major complications (MCs) and long-term survival. Preoperative TEE was performed in 1191 patients undergoing TLE. Lead thickening (OR = 1.536; = 0.007), lead adhesion to heart structures (OR = 2.531; < 0.001) and abnormally long lead loops (OR = 1.632; = 0.006) increased the complexity of TLE. Vegetation-like masses on the lead (OR = 4.080; = 0.44), lead thickening (OR = 2.389; = 0.049) and lead adhesion to heart structures (OR = 6.341; < 0.001) increased the rate of MCs. The presence of vegetations (HR = 7.254; < 0.001) was the strongest predictor of death during a 1-year follow-up period. TEE before TLE provides a lot of important information for the operator. Apart from the visualization of possible vegetations, it can also detect various forms of lead-related scar tissue. Build-up of scar tissue and the presence of long lead loops are associated with increased complexity of the procedure and risk of MCs. Preoperative TEE performed outside the operating room may have an impact on the clinical decision-making process, such as transferring potentially more difficult patients to a more experienced center or having the procedure performed by the most experienced operator. Moreover, the presence of masses or vegetations on the leads significantly increases 1-year and all-cause mortality.
经静脉导线拔除术（TLE）前必须进行经食管超声心动图（TEE）检查，但其作用仍被低估。本研究旨在描述TLE候选患者中TEE检查结果的广泛范围，以及这些结果对手术复杂性、主要并发症（MCs）和长期生存的影响。对1191例接受TLE的患者进行了术前TEE检查。导线增厚（OR = 1.536；P = 0.007）、导线与心脏结构粘连（OR = 2.531；P < 0.001）和导线环异常长（OR = 1.632；P = 0.006）会增加TLE的复杂性。导线上类似赘生物的团块（OR = 4.080；P = 0.44）、导线增厚（OR = 2.389；P = 0.049）和导线与心脏结构粘连（OR = 6.341；P < 0.001）会增加MCs的发生率。赘生物的存在（HR = 7.254；P < 0.001）是1年随访期内死亡的最强预测因素。TLE前的TEE为术者提供了许多重要信息。除了可视化可能存在的赘生物外，它还能检测出各种形式的与导线相关的瘢痕组织。瘢痕组织的形成和长导线环的存在与手术复杂性增加和MCs风险相关。在手术室以外进行的术前TEE可能会影响临床决策过程，例如将潜在难度更大的患者转至经验更丰富的中心，或由经验最丰富的术者进行手术。此外，导线上出现团块或赘生物会显著增加1年死亡率和全因死亡率。
