ESTUDO PROSPECTIVO DE EVENTOS TROMBOEMBÓLICOS APÓS REOPERAÇÕES DE ALTA COMPLEXIDADE EM ESTIMULAÇÃO CARDÍACA ARTIFICIAL DEFINITIVA

• Palavras-chave: Palavras-chave

• Keywords: : cardiac pacing, artificial; postoperative complications; venous thrombosis; pulmonary embolism

• Abstract:

  Background: Venous obstructions are frequent in patients with transvenous leads although related clinical findings are rarely reported. After lead replacement or upgrade these lesions are even more frequent, but there is still no evidence to support this observation.

  Objective: To investigate the incidence and possible risk factors for upper extremity deep venous thrombosis (UEDVT) and pulmonary embolism (PE) after lead replacement or upgrade procedures.

  Methods: Prospective cohort carried out between April 2013 and July 2016. Preoperative evaluation included venous ultrasound and pulmonary angiotomography. Diagnostic exams were repeated postoperatively to detect the study outcomes. Student's t test, Chi-square or Fisher's Exact test were used in the univariate analysis. Multivariate logistic regression models were used to identify prognostic factors.

  Results: Among the 84 patients included, there was a balance between gender and mean age was 59.3 ± 15.2 years. Lead malfunctioning (75.0%) was the main surgical procedure indication. Lead removal was performed in 52.4% of the cases. The rate of postoperative UEDVT and PE was 28.6% and 7.1%, respectively. Independent prognostic factors for UEDVT were severe collateral circulation in the preoperative venography (OR= 4.7 [95% CI= 1.1-19.8], P= 0.037) and lead extraction (OR= 27.4 [95% CI 5.8-128.8], P<0.0001). 

  Conclusion: Reoperations involving previously transvenous implanted leads present high rates of thromboembolic complications. Transvenous lead extraction had a significant impact on the development of UEDVT. These results show the need of further studies to evaluate the role of preventive strategies for this subgroup of patients.

• Número de páginas: 16