应用杂交技术拔除高危心内植入型电子装置的临床总结

Clinical summary of removal of high-risk cardiac implantable electronic devices using hybrid technique

目的:总结回顾杂交技术处理心内植入型电子装置(CIED)相关并发症的临床效果。方法:回顾性分析2012年5月—2018年12月因CIED相关感染或电极穿孔在我院应用择期杂交技术(小切口开胸直视心脏结合透视下经静脉拔除心内导线)行CIED拔除病例为研究组(杂交组,29例),回顾分析入选人群的病例资料。并以同期行择期常规正中开胸体外循环下去除CIED病例作为对照组(常规组,17例)。结果:29例病例中,采用半胸骨劈开18例(62.1%),左前外侧5肋间切口7例(24.1%),全胸骨劈开2例(6.9%),全胸腔镜辅助2例(6.9%),术中中转正中开胸2例(6.9%)。相较于常规组,杂交组并不增加右心耳出血、三尖瓣反流、电极残留、肺栓塞等主要并发症风险(P>0.05),表现出更少的出血(100 mL vs 600 mL,P=0.033)和用血量(0 U vs 8 U,P<0.001),更短的机械通气时间(5.0 h vs 12.0 h,P=0.024)和术后监护时间(16.5 h vs 44.5 h,P=0.045),术后住院时间也大大缩短[(15.41±9.30)d vs(32.29±13.61)d,P=0.029]。杂交组住院期间无死亡病例。结论:在有条件的单位,对于经某些静脉拔除CIED高危患者或者同期需要行心外膜永久起搏器植入患者,采用杂交技术处理是安全且有效的。

Objective:To summarize the clinical results of hybrid technique in the treatment of complications related to cardiac implantable electronic devices(CIED).Methods:Twenty-nine patients who underwent CIED extirpation due to CIED-related infection or electrode perforation from 2012.5 to 2018.12 in our center were included(hybrid group,n=29).The case data of the selected population were analyzed retrospectively.Results:Among the 29 cases,semi-sternum split in 18 cases(62.1%),left anterolateral incision in 7 cases(24.1%),total thoracotomy in 2 cases(6.9%),total thoracoscopy assisted in 2 cases(6.9%).Extra median thoracotomy was performed in 2 cases(6.9%).Compared with patients undergoing conventional cardiopulmonary bypass(control group,n=17),the hybrid group did not increase the risk of major complications such as right atrial tearing,acute tricuspid regurgitation,electrode residue,and pulmonary embolism(P>0.05)It showed less bleeding(100 mL vs 600 mL,P=0.033),blood transfusion(0 U vs 8 U,P<0.001),shorter mechanical ventilation time(5.0 h vs 12.0 h,P=0.024)and ICU time(16.5 h vs 44.5 h,P=0.045)in the hybrid group.The postoperative hospital stay was also greatly shortened[(15.41±9.30)d vs(32.29±13.61)d,P=0.029].There was no death during hospitalization in the hybrid group.Conclusion:The hybrid technique is safe and effective for patients with high risk of CIED extraction or patients who need permanent epicardial pacemaker implantation at the same time.