Safety and feasibility of same-day discharge following uncomplicated transvenous lead extraction.

Autor: Gianni C; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Elchouemi M; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Helmy R; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Spinetta L; Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA.; Cardiothoracic and Vascular Surgeons, Austin, Texas, USA., La Fazia VM; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Pierucci N; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.; Department of Clinical Internal Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy., Asfour I; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.; Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA., Della Rocca DG; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Mohanty S; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Bassiouny MA; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Coffeen PC; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Hranitzky PM; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Neely RC; Cardiothoracic and Vascular Surgeons, Austin, Texas, USA., Natale A; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.; HCA National Medical Director of Cardiac Electrophysiology, Nashville, Tennessee, USA.; Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA.; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Ohio, Cleveland, USA., Canby RC; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA., Al-Ahmad A; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2024 Feb; Vol. 35 (2), pp. 278-287. Date of Electronic Publication: 2023 Dec 10.
DOI: 10.1111/jce.16147
Abstrakt: Introduction: Transvenous lead extraction (TLE), while mostly a safe procedure, has risk of serious periprocedural complications. As such, overnight hospitalization remains a routine practice. In our center, we routinely discharge patients on the same day following an uncomplicated TLE.
Methods: This is a retrospective study of 265 consecutive patients who underwent uncomplicated TLE in our center between 2019 and 2021. Same-day discharge (SDD) patients are compared with those who stayed at least overnight for observation after the TLE procedure (non-SDD group). To assess the safety of an SDD strategy after uncomplicated TLE, the main study endpoint was to compare the rate of major procedure-related complications at 1-, 7-, and 30-days. To identify the factors influencing the operator's decision to discharge the patient on the same day, the secondary endpoint was to analyze clinical and procedural predictors of SDD.
Results: A total of 153 patients were discharged the same day after uncomplicated TLE (SDD), while 112 stayed at least overnight after the procedure (non-SDD). There was no significant difference in major procedure-related complications at 1-day (SDD 0% vs. non-SDD 1.8%, p value = ns), while patients in the SDD group had a lower rate of 7- and 30-day complications when compared with those in the non-SDD group (2.1% vs. 8.2%, p value = .0308; and 3.5% vs. 16%, p value = .0049, respectively). Noninfectious indication for TLE (OR 16.1, 95% confidence interval [CI] 4.29-77.6) and procedure end time before 12:00 (OR 2.82, 95% CI 1.11-7.27) were the only independent predictors of SDD.
Conclusion: SDD discharge following uncomplicated TLE in selected patients (i.e., those without device infection and when the TLE procedure is completed in the morning) is feasible and safe.
(© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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