杂交技术治疗右心室迟发导线穿孔

Hybrid technique in management of late lead right ventricular perforation

目的探讨杂交技术治疗迟发右心室导线穿孔的安全必要性。方法查阅北京大学人民医院心脏中心2012年1月1日至2018年12月31日导线拔除数据库,收集所有因迟发导线穿孔行杂交手术治疗的患者。记录这些患者的年龄、性别、植入装置类型、植入装置时间、穿孔发现时间、临床表现、手术方式、治疗转归等,并回顾这些患者的手术记录及术中录像、照片资料,总结术中发现。结果2012年1月1日至2018年12月31日,共1124例患者于我中心行导线拔除治疗,其中导线穿孔患者29例,8例迟发导线穿孔患者应用杂交技术治疗。8例患者中男5例,年龄(61.8±8.6)岁,除颤导线2例,起搏导线6例。杂交技术为外科开胸(1例常规正中开胸,1例胸骨下段切口,6例左前外侧小切口)加经静脉拔除导线。所有患者均顺利完成手术,无并发症发生。术中发现,未穿出心包的导线光滑,无纤维组织粘连,穿出心包的导线头端多与组织有一定程度粘连。术后住院时间为(9.88±3.18)d。术后随访(42.6±19.3)个月,未再有穿孔或导线功能异常复发。结论杂交技术是治疗迟发心脏导线穿孔的有效方法,尤适用于导线穿出心包外的患者。

Objective To evaluate the safety and the necessity of hybrid technique in management of late lead perforation.Methods The database of lead extraction in Heart Center of People’s Hospital from January 1st 2012 to December 31st 2018 was consulted to select the data of all the patients who underwent hybrid surgery due to late lead perforation.All medical records were reviewed including patient demographics,type of devices,time of perforation diagnosis,clinical manifestation,operation details and outcomes.Their operation records and in operation video or photo pictures were reviewed and analyzed.Results One thousand one hundred and twenty-four cases of lead extraction cases were carried out in our center from January 1st 2012 to December 31st 2018.Twenty-nine patients were diagnosed with lead perforation.Among them,8 patients were late lead perforation and treated with hybrid technique.There were 5 males and 3 females with mean age of(61.8±8.6)years.Three implantable cardioverter defibrillator(ICD)leads and 5 pacemaker leads were extracted.The hybrid technique was combined with surgical thoracotomy(1 standard median sternotomy,1 lower partial midline sternotomy and 6 minimal left anterior lateral thoracotomy)plus transvenous lead extraction.All the patients were accomplished operation successfully,and there were no complications.Data showed that the perforated leads were smooth,and no tissue attached when it stayed inside pericardial sac.However,there were some fabric tissue attaching to its tip when the lead perforated through pericardial sac.In-hospital days after operation was(9.88±3.18)days.The follow-up time was(42.6±19.3)months.All the patients stayed in good health,and no perforation recurred.Conclusion Hybrid technique is an effective technique for management of late lead perforation,especially for those patients whose lead has perforated out of pericardial sac.