BackgroundLead dwell time is the single strongest predictor of failure and complications in transvenous lead extraction.ObjectivesTo report the success rate and complications of transvenous lead extractions with implant dwell time of at least 15 years.MethodsProcedural and patient data were prospectively collected into a database. The excimer laser was the primary method for lead extraction with the use of mechanical rotational sheaths and femoral snares at operator discretion.ResultsA total of 442 patients between 2011 and 2020 underwent lead extraction (705 leads) primarily for infection or device failure at our high‐volume center. Forty‐one patients with 71 leads > 15 years old were included in this cohort. Mean patient age was 53.5 ± 18.5 years, 67.5% were male. Mean lead dwell time was 19.6 ± 4.4 years. Thirty‐six of 41 (88%) patients had successful extraction of all leads compared to 96% in the remaining 401 patients, p value.004. Of the five patients without fully successful extractions two of these patients had abandoned leads (three total) that were clinically significant. There were two (4.9%) major complications in the very old lead group and six (1.5%) in the other group. In the very old lead group, one patient experienced right atrial appendage perforation requiring surgical repair and recovered well. One patient experienced new complete heart block requiring 2 min of CPR but did well thereafter. There was no procedure‐related mortality.ConclusionsDespite challenges posed by older leads, very old leads can be safely and effectively extracted with low complication rates.

中文翻译：

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淘汰老人：单中心经静脉抽取 15 岁以上导线的经验

背景导线停留时间是经静脉导线拔除失败和并发症的最强预测因素。目的报告植入物停留时间至少 15 年的经静脉导线拔除的成功率和并发症。方法前瞻性地将程序和患者数据收集到数据库中。准分子激光是拔除导线的主要方法，由操作员酌情使用机械旋转鞘和股骨圈套器。结果 2011 年至 2020 年间，共有 442 名患者接受了导线拔除（705 根导线），主要是因为感染或装置故障，我们的高音量中心。该队列包括 41 名年龄 > 15 岁的患者（71 条导联）。患者平均年龄为 53.5 ± 18.5 岁，其中 67.5% 为男性。平均引导停留时间为 19.6 ± 4.4 年。 41 名患者中的 36 名 (88%) 成功拔出了所有导联，而其余 401 名患者中的这一比例为 96%，p值.004。在未完全成功拔除的五名患者中，其中两名患者放弃了具有临床意义的引线（总共三名）。高龄导线组有 2 例（4.9%）主要并发症，另一组有 6 例（1.5%）。在非常老的领导组中，一名患者经历了右心耳穿孔，需要进行手术修复，并且恢复良好。一名患者出现了新的完全性心脏传导阻滞，需要 2 分钟的心肺复苏，但此后情况良好。没有出现与手术相关的死亡率。结论尽管老年导线带来了挑战，但非常旧的导线可以安全有效地拔除，并发症发生率较低。