心脏植入式电子设备患者的外科围术期处理和心血管结局——回顾性队列研究

Perioperative management and cardiovascular outcomes of patients with cardiac implantable electronic device undergoing surgery-a single center retrospective cohort study

目的:调查当前心脏植入式电子设备(CIED)患者外科手术围术期评估和管理措施,探讨目前处理流程与共识推荐的差距,以及与CIED患者围术期心脏结局的关系。方法:回顾性队列研究近2年来在本中心进行外科手术并具有CIED的患者。结果:纳入2020年7月—2022年7月在本中心接受外科手术的CIED患者共104例,平均年龄(73±11)岁,女性49例。术前评估发现12.5%的患者在手术科室未能确认其具有CIED,多达80.8%的会诊申请未能提供CIED类型及型号,49.0%的患者既往没有规律程控随访,总体术前评估与共识建议依从度仅8%。择期手术前准备时,所有患者均由专业随访护士联系电生理医师进行了CIED程控,获得CIED功能状态和电量的信息,并建议术中采用减少电磁干扰(EMI)和备用起搏/除颤的措施。部分CIED患者术前程控更改为非同步模式,术后由专业随访护士再次联系电生理医师程控确认参数良好,并恢复原工作模式。术前准备及术后管理流程与共识推荐依从度均达100%。术前因程控发现问题造成手术延迟2例,取消1例。CIED相关的复合终点事件发生共5例(4.8%),均与术前不规范的评估流程相关。围手术期心脏事件发生28例(27.2%),但均与CIED围术期处理无关。结论:目前CIED患者外科手术围术期评估过程与国际共识建议存在差距,专业规范的CIED围术期管理对避免手术延搁,降低围手术期器械和心脏事件的发生具有重要作用。

Objective We aimed to investigate the gap between current perioperative assessment and management for patients with cardiac implantable electronic devices(CIED)and recommendations from consensus,and to explore its possible association with the perioperative adverse outcomes involving CIED and cardiovascular events.A professional nurse-led perioperative workflow were suggested as a quality-improvement approach.Methods A retrospective cohort study was performed on patients with CIED who underwent surgery in our center in the past two years.Results A total of 104 CIED patients undergoing surgery in our center from July 2020 to July 2022 were enrolled.The average age of the subjects was(73±11)years,and 49 of them were females.In preoperative evaluation,it was found that up to 12.5%of patients failed to confirm the status of their CIED in the surgery ward,and 80.8%of the consultations failed to provide the type and model of the CIED,49.0%of patients did not take regular follow-up for their devices.The general adherence of the practical preoperational evaluation to the current consensus was 8%.Before elective surgery,all patients were contacted by professional nurses for arranging cardiac electrophysiologist to interrogate and obtain information on the functional and battery status of CIED.Measures to avoid electromagnetic interference(EMI)and to provide pacing/defibrillation backup were recommended.Some patients were programmed to asynchronous mode before the operations.Professional nurses were contact after the operations and the CIED parameters were confirmed and re-programmed to the original mode.The general adherence of the practical preoperational and post-operational management to the current consensus was 100%.Two surgeries were delayed,and one was canceled due to CIED dysfunction found in the interrogation.The overall CIED-related composite events were found in 5 cases(4.8%),all of which were associated with inappropriate preoperational evaluation.The perioperative cardiac events occurred in 28 cases(27.2%)although no correlation was found between the occurrence and the perioperative management of CIED.Conclusion There is a gap between the perioperative evaluation of CIED patients in current clinical practice and the international consensus recommendations.Multidisciplinary collaboration and standardized perioperative management of CIED are essential to avoid surgery delays and reduce perioperative cardiac adverse events.