Predictors of venous stenosis or occlusion following first transvenous cardiac device implantation: Prospective observational study
Predictors of venous stenosis or occlusion following first transvenous cardiac device implantation: Prospective observational study
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DOI：
10.1177/1129729818815135
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发表时间：
2019-09-01
影响因子：
1.9
通讯作者：
Grabowski, Marcin
中科院分区：
文献类型：
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作者：
Cacko, Andrzej;Kozyra-Pydys, Eliza;Grabowski, Marcin
引言：与心内器械相关的静脉狭窄或闭塞是该手术的常见并发症。有许多研究试图确定静脉狭窄或闭塞的预测因素;然而，其中大多数研究在器械升级、发生器更换或经静脉电极导线拔除之前对静脉系统进行了研究。因此，我们旨在评估首次经静脉心脏器械植入后静脉狭窄或闭塞的患病率并确定其预测因素。方法：观察性、前瞻性研究包括71例首次经静脉心脏装置植入的连续患者。术后随访6个月。结果如下：植入器械系统包括心律转复除颤器（n = 26）、单腔或双腔起搏器（n = 34）和双心室起搏器（n = 11）; 88.5%的植入式心律转复除颤器电极导线为单线圈，11.5%为双线圈。随访6个月内静脉狭窄或闭塞的发生率为21.1%。多因素Logistic回归分析显示，只有糖尿病或糖尿病前期（p = 0.033，比值比：0.17，95%置信区间：0.04-0.87），手术时间延长（p = 0.046，比值比：4.54，95%置信区间：1.01-20.12），以及围手术期并发症（p = 0.021，比值比：7.04，95%置信区间：1.35-36.85）是静脉狭窄或闭塞的预测因子。结论：植入时间延长（>60 min）和围手术期并发症与静脉狭窄或闭塞风险增加相关，而糖尿病和前驱糖尿病可显著降低静脉狭窄或闭塞风险。
Introduction: Venous stenosis or occlusion related to an intracardiac device is a well-known complication of that procedure. There are numerous studies tried to determine predictors of venous stenosis or occlusion; however, most of them investigate the venous system prior to device upgrade, generator replacement, or transvenous lead extraction. Therefore, we aimed to assess the prevalence and determine the predictors of venous stenosis or occlusion following first transevnous cardiac device implantation. Methods: Observational, prospective study included 71 consecutive patients admitted for first transvenous cardiac device implantation. All patients were followed up for 6 months after operation. Results: Implanted device systems comprised cardioverter defibrillator (n = 26), single-chamber or dual-chamber pacemakers (n = 34), and biventricular pacemakers (n = 11); 88.5% of implantable cardioverter defibrillator leads were single-coils and 11.5% were dual-coils. The incidence of venous stenosis or occlusion within 6-month follow-up was 21.1%. Multivariate logistic regression showed that only diabetes or prediabetes (p = 0.033, odds ratio: 0.17, 95% confidence interval: 0.04-0.87), prolonged procedure time (p = 0.046, odds ratio: 4.54, 95% confidence interval: 1.01-20.12), and perioperative complications (p = 0.021, odds ratio: 7.04, 95% confidence interval: 1.35-36.85) were predictors of venous stenosis or occlusion. Conclusion: Prolonged implantation time (>60 min) and perioperative complications are associated with an increased risk of venous stenosis or occlusion, whereas diabetes and prediabetes significantly reduce the risk of venous stenosis or occlusion.