Effect of Prior Sternotomy on Outcomes in Transvenous Lead Extraction.

D. Tsang, Adryan A Perez, T. Boyle, R. Carrillo
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引用次数: 6

Abstract

BACKGROUND A history of open-heart surgery has been a heavily debated topic in transvenous lead extraction. This study evaluates the impact of prior sternotomy on transvenous lead extraction outcomes. METHODS Data for all patients undergoing transvenous lead extraction at a tertiary referral center were prospectively gathered from 2004 to 2017. Relevant clinical information was compared between patients with a history of sternotomy before transvenous lead extraction and those without. After considering baseline differences, multivariate regression, and propensity-matched analysis were performed. Outcome variables included major and minor complication rates, clinical success, and in-hospital mortality as defined by the 2017 Heart Rhythm Society consensus statement. RESULTS Of 1480 patients in the study period, 455 had a prior sternotomy. When compared with patients with no prior sternotomy, those with prior sternotomy were more likely to be older, male, and present with more comorbidities and leads targeted for extraction. No statistical differences were identified in major and minor complication rates (P=0.75, P=0.41), clinical success rate (P=0.26), and in-hospital mortality (P=0.08). In patients with prior sternotomy, there were no instances of pericardial effusion after extraction. Prior sternotomy was not an independent predictor of clinical or procedural outcomes. No associations were elucidated after propensity-matched analysis. CONCLUSIONS In a large, single-center series, no differences in clinical or procedural outcomes were elucidated between patients with a history of sternotomy and those without. Patients with sternotomies before lead extraction who experienced vascular or cardiac perforations clinically presented with hemothoraces rather than pericardial effusions.
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先前胸骨切开对经静脉铅提取结果的影响。
背景:心内直视手术的历史在经静脉铅提取中一直是一个备受争议的话题。本研究评估先前胸骨切开术对经静脉铅提取结果的影响。方法前瞻性收集2004年至2017年在三级转诊中心接受经静脉铅提取的所有患者的数据。比较经静脉拔铅前有胸骨切开术和无胸骨切开术患者的相关临床资料。在考虑基线差异后,进行多元回归和倾向匹配分析。结果变量包括2017年心律学会共识声明中定义的主要和次要并发症发生率、临床成功率和住院死亡率。结果在研究期间的1480例患者中,455例既往胸骨切开术。与没有胸骨切开术的患者相比,有胸骨切开术的患者更可能是年龄较大的男性,并且存在更多的合并症和引线。轻重并发症发生率(P=0.75, P=0.41)、临床成功率(P=0.26)、住院死亡率(P=0.08)差异均无统计学意义。在既往胸骨切开术的患者中,取出后无心包积液。既往胸骨切开术并不是临床或手术结果的独立预测因子。倾向匹配分析后未发现关联。结论在一项大型单中心研究中,有胸骨切开术史和没有胸骨切开术史的患者在临床或手术结果上没有差异。在拔铅前行胸骨切开术且有血管或心脏穿孔的患者临床表现为胸血而非心包积液。
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