| Objective:To analyze the case characteristics and perioperative management of the transvenous lead extraction with excimer laser sheath system and to clarify the indications,procedural results and prognostic factors of the system,so as to provide experience for follow-up utilization.Methods:The clinical and procedural data of patients undergoing transvenous lead extraction with excimer laser sheath system in Fuwai Hospital of Chinese Academy of Medical Sciences from January 2016 to December 2019 were collected and followed up.The characteristics of the patients,the safety and effectiveness of the procedure were analyzed retrospectively.Results:A total of 15 patients who accepted TLE,with an average age of 59.3 ± 15.4 years,,including 11 males(73.3%),were treated with excimer laser sheath system.The causes of previous implantation of CIED were sick sinus syndrome in 7 cases(53.3%),third-degree atrioventricular block in 7 cases(40%,including 1 case with dilated cardiomyopathy,1 case with atrial fibrillation),and 1 case with ventricular tachycardia(6.7%).The type of implanted CIED was DDD in 12 cases(80%)and ICD,CRT-P and VVI in 1 case(6.7%)respectively.The average implantation time of leads was 12.0 17.2(22.26)years,the median number of leads implanted in each patient is 2,and the quartile spacing is 1.The indications for operation were device-related infection in 13 cases(86.7%)and lead failure in 2 cases(13.3%).Thirteen patients also suffered from other types of diseases,including severe coronary heart disease,cardiac insufficiency,decompensation of liver cirrhosis,etc.;all patients had varying degrees of venous stenosis or adhesion.Results of the operation:SLS ? laser sheath was the first choice for the separation of adhesive tissue in all cases.Four patients(26.7%)had leads broken during the operation,and the broken leads were extracted by the inferior vena cava device.One case was dealt by the combination of internal medicine and surgery because of the rupture of the right atrium during the operation.11 cases(73.3%)were completely successful,3 cases(20.0%)were clinically successful,and 1 cases failed(6.7%);31 leads(81.6%,31/38)were completely extracted with the laser sheath.Among them,15 atrial leads(100%)were completely extracted and 17 ventricular leads(73.9%,17/23)were completely removed.Severe complications occurred in 1 case(6.7%,pericardial tamponade that cannot be relieved by pericardiocentesis,surgical thoracotomy to repair the right atrium and remove the ventricular leads)and minor complications in 2 case(13.3%).One patient with serious complications recovered well and had no obvious sequelae,and one patient with decompensated liver cirrhosis had no signs of infection such as fever but died of liver cirrhosis 3 months later.With sufficient anti-infective treatments,the infection symptoms,signs and laboratory examination results were completely controlled in all patients who underwent lead extraction because of equipment infection.Conclusion:In this study,the success rate of laser lead extraction is higher,the incidence of complications and mortality are lower,and the success rate of atrial lead is higher than that of ventricular lead.Cardiovascular implant-related infections and nonfunctional/discarded leads are the main indications for transvenous lead extraction.PET/CT can be used to identify patients with suspected infections that cannot be diagnosed.Elderly women,superior vena cava occlusion or stenosis/calcification adhesion,longer lead implantation time,need to remove more than three leads or use a variety of sheath tubes will greatly increase the difficulty of TLE,and are more prone to serious complications such as pericardial tamponade.When serious complications occur during TLE,surgical repair should be performed immediately,preferably in a hybrid operating room,and keeping in close contact with the surgical team and anesthesiologist. |
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