一项回顾性结果研究:经静脉铅提取在特定CIED感染患者中的替代方法

Jennifer J. Llewellyn, G. Meda, D. Garner, D. Wright, A. Rao
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引用次数: 0

摘要

心脏植入式电子装置(CIED)植入物在年龄较大、合并症较多的人群中呈上升趋势。CIED的感染率在1-4%之间。虽然对于感染、侵蚀或预侵蚀的cied,建议完全取出所有经静脉硬体,但这种方法并非没有风险,有些患者可能无法接受。缺乏更为保守策略的长期数据。我们报告我们的经验,保守管理与口袋翻修作为主要策略,精心挑选的患者。方法:回顾性分析在一家大型三级中心进行的所有CIED修订程序,为期7年,平均随访时间为39个月。结果:86例患者共进行了96次翻修手术;随访结束时,7例患者需要进一步修复,13例患者继续接受CIED拔除。12个月时的总死亡率为8.1%,在随访期结束时上升至24.4%。结论:我们的数据提供了重要的结果信息,在精心选择的患者中,拔牙的风险被认为是不可接受的。没有全身性感染似乎预示着比以前报道的更好的结果,超过三分之二的患者在12个月时仍然无并发症。
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An Alternative to Transvenous Lead Extraction in Selected Patients with CIED Infections—A Retrospective Outcome Study
Cardiac implantable electronic device (CIED) implants are rising in an older, more co-morbid population. The prevalence of CIED infection ranges from 1–4%. Whilst complete extraction of all transvenous hardware is recommended for infected, eroded, or pre-eroding CIEDs, this approach is not without risk and may be unacceptable to some patients. Long-term data on a more conservative strategy is lacking. We report on our experience of conservative management with pocket revision as a primary strategy in carefully selected patients. Method: A retrospective review of all CIED revision procedures was undertaken at a large tertiary center, over a 7-year period, with a mean follow-up timeframe of 39 months. Results: A total of 86 patients underwent 96 revision procedures; 7 patients required further revisions and 13 went on to undergo CIED extraction by the end of the follow-up period. The overall rate of mortality at 12 months was 8.1%, increasing to 24.4% at the end of the follow-up period. Conclusion: Our data provide important outcome information on an alternative strategy to lead extraction in carefully selected patients where the risk of extraction is perceived to be unacceptable. The absence of systemic infection appears to predict better outcomes than previously reported, and over two-thirds of patients remained complication-free at 12 months.
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