经静脉移除除颤导线单中心经验

Transvenous defibrillation leads extraction:a single-center experience

目的探究经静脉移除除颤导线的安全性及有效性。方法本文为回顾性研究。收集2015年7月至2022年6月于南京大学医学院附属鼓楼医院心内科移除除颤导线患者共48例,分析患者基线资料、导线移除适应证、移除工具、移除成功率、并发症发生率。结果研究纳入48例患者,其中男41例,女7例,年龄(58.79±14.62)岁,年龄范围18~91岁。其中感染患者38例,除颤导线故障7例,因需要磁共振检查2例,慢性疼痛1例。共移除51根除颤导线,其中双线圈除颤导线33根,单线圈除颤导线18根。其中2根徒手移除,10根使用锁定导丝移除,36根使用机械扩张鞘移除,3根使用机械扩张鞘联合针眼圈套器移除。手术成功导线完全移除50根(完全成功率98.03%,50/51),临床成功1根。1例患者发生严重并发症,为心脏压塞(严重并发症发生率2.08%,1/48)。结论经静脉除颤导线移除技术安全有效。

Objective To investigate the safety and efficacy of transvenous defibrillation leads extraction.Methods From July 2015 to June 2022,a total of 48 patients with transvenous defibrillation lead extraction in Department of Cardiology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School were selected.The baseline data,indications for lead extraction,tools for lead extraction,success rate and incidence of complications were retrospectively analyzed.Results There were 51 defibrillation leads in the 48 patients extracted.There were 41 males and 7 females,aged(58.79±14.62)years,ranging from 18 to 91 years.There were 38 cases of infection,7 cases of defibrillation lead failure,2 cases of a strong demand for magnetic resonance imaging,and 1 case of chronic pain.Thirty-three double-coil defibrillation leads and 18 single-coil defibrillation leads were extracted.Two leads were extracted by hand,10 leads were extracted by locking stylets,36 leads were removed by Evolution mechanical sheath,and 3 were removed by Evolution mechanical sheath combined with Needle’s Eye Snare.Fifty leads were successfully extracted(complete success rate 98.03%,50/51),and 1 wire was successfully extracted clinically.One patient had a serious complication,which was cardiac tamponade(2.08%,1/48).Conclusion Transvenous defibrillation leads extraction is safe and effective.