欧洲小容量中心无现场手术支持的经静脉铅提取

Pub Date : 2023-09-07 DOI:10.3390/reports6030041

Mohamed Dardari, C. Iorgulescu, V. Bataila, A. Deaconu, E. Cinteză, R. Vatasescu, Paul Padovani, C. Vasile, M. Dorobanțu

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引用次数: 0

摘要

心脏植入式电子装置(cied)的适应症正在增加。几乎三分之一的器械相关感染是心内膜炎。经静脉铅提取(TLE)已成为治疗器械相关感染和并发症的一种有效和安全的方法。世界范围内正在使用多种类型的提取工具。我们的目标是评估使用无动力拔牙工具进行TLE的安全性和有效性。该研究包括2018年10月至2022年7月期间需要TLE的患者，根据EHRA专家关于拔铅的共识建议。共纳入88例连续患者。TLE的适应症包括74%患者的器械相关感染。其中，32%患有与器械相关的心内膜炎，伴有或不伴有败血症。在心内膜炎和阳性菌血症患者中，金黄色葡萄球菌是最常见的病原体，57%的患者血液培养呈阴性。总共有150个心脏起搏和除颤器导联被选中进行提取。导联平均停留时间为6.92±4.4年;5岁以上的占52.8%，10岁以上的占15.8%，最长导联停留时间为26年。患者年龄18 ~ 98岁，平均66±16岁。67%的患者是男性。仅使用非动力拔牙工具，我们报告了93.3%的导联完全去除和99%的部分拔牙临床成功率。我们没有报告手术相关死亡或重大并发症。轻微并发症发生率为6.8%，所有并发症均自行消退。30天死亡率为3.4%。使用无动力拔牙工具的TLE即使在没有手术支持的情况下也是安全有效的。

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Transvenous Lead Extraction in a European Low-Volume Center without On-Site Surgical Support

Indications for cardiac implantable electronic devices (CIEDs) are increasing. Almost one-third of device-related infections are endocarditis. Transvenous lead extraction (TLE) has emerged as an effective and safe approach for treating device-related infections and complications. Multiple types of extraction tools are being used worldwide. Our goal is to evaluate the safety and effectiveness of TLE using non-powered extraction tools. The study included patients between October 2018 and July 2022 requiring TLE according to EHRA expert consensus recommendations on lead extraction. A total of 88 consecutive patients were included. Indications for TLE included device-related infections in 74% of the patients. Of those, 32% had device-related endocarditis with or without sepsis. Staphylococcus Aureus was the most frequent pathogen in patients with endocarditis and positive bacteremia, and 57% had negative bloodstream cultures. A total of 150 cardiac pacing and defibrillator leads were targeted for extraction. The mean dwell time for leads was 6.92 ± 4.4 years; 52.8% were older than 5 years, 15.8% were older than ten years, and the longest lead dwell time was 26 years. Patients’ age varied between 18 and 98, with a mean age of 66 ± 16 years. Sixty-seven percent of patients were males. Using only non-powered extraction tools, we report 93.3% complete lead removal and 99% clinical success with partial extraction. We report no procedure-related death nor major complications. Minor complication incidence was 6.8%, and all complications resolved spontaneously. The 30-day mortality rate was 3.4%. TLE using non-powered extraction tools is safe and effective even without surgical backup on site.

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