PDF(Pubmed)
Abstract：
Transvenous lead extraction (TLE) is performed using non-laser and laser techniques with overall high efficacy and safety. Variation in outcomes between the two approaches does exist with limited comparative evidence in the literature. We sought to compare non-laser and laser TLE in a meta-analysis.
We searched Medline, Embase, Scopus, ClinicalTrials.gov, and CENTRAL databases for TLE studies published between 1991 and 2021. From the included 68 studies, safety and efficacy data were carefully evaluated and extracted. Aggregated cases of outcomes were used to calculate odds ratio (OR), and pooled rates were synthesized from eligible studies to compare non-laser and laser techniques. Subgroup comparison of rotational tool and laser extraction was also performed. Non-laser in comparison with laser had lower procedural mortality (pooled rate 0% vs. 0.1%, P < 0.01), major complications (pooled rate 0.7% vs. 1.7%, P < 0.01), and superior vena cava (SVC) injury (pooled rate 0% vs. 0.5%, P < 0.001), with higher complete success (pooled rate 96.5% vs. 93.8%, P < 0.01). Non-laser comparatively to laser was more likely to achieve clinical [OR 2.16 (1.77-2.63), P < 0.01] and complete [OR 1.87 (1.69-2.08), P < 0.01] success, with a lower procedural mortality risk [OR 1.6 (1.02-2.5), P < 0.05]. In the subgroup analysis, rotational tool compared with laser achieved greater complete success (pooled rate 97.4% vs. 95%, P < 0.01) with lower SVC injury (pooled rate 0% vs. 0.7%, P < 0.01).
Non-laser TLE is associated with a better safety and efficacy profile when compared with laser methods. There is a greater risk of SVC injury associated with laser sheath extraction.
We searched Medline, Embase, Scopus, ClinicalTrials.gov, and CENTRAL databases for TLE studies published between 1991 and 2021. From the included 68 studies, safety and efficacy data were carefully evaluated and extracted. Aggregated cases of outcomes were used to calculate odds ratio (OR), and pooled rates were synthesized from eligible studies to compare non-laser and laser techniques. Subgroup comparison of rotational tool and laser extraction was also performed. Non-laser in comparison with laser had lower procedural mortality (pooled rate 0% vs. 0.1%, P < 0.01), major complications (pooled rate 0.7% vs. 1.7%, P < 0.01), and superior vena cava (SVC) injury (pooled rate 0% vs. 0.5%, P < 0.001), with higher complete success (pooled rate 96.5% vs. 93.8%, P < 0.01). Non-laser comparatively to laser was more likely to achieve clinical [OR 2.16 (1.77-2.63), P < 0.01] and complete [OR 1.87 (1.69-2.08), P < 0.01] success, with a lower procedural mortality risk [OR 1.6 (1.02-2.5), P < 0.05]. In the subgroup analysis, rotational tool compared with laser achieved greater complete success (pooled rate 97.4% vs. 95%, P < 0.01) with lower SVC injury (pooled rate 0% vs. 0.7%, P < 0.01).
Non-laser TLE is associated with a better safety and efficacy profile when compared with laser methods. There is a greater risk of SVC injury associated with laser sheath extraction.
摘要：
背景：使用非激光和激光技术进行经静脉引线提取（TLE），具有整体高疗效和安全性。两种方法之间的结果差异确实存在，文献中的比较证据有限。
目的：我们试图在荟萃分析中比较非激光和激光TLE。
方法：我们搜索了Medline，Embase,Scopus,1991-2021年间发表的TLE研究的ClinicalTrials.gov和CENTRAL数据库。从纳入的68项研究中，我们仔细评估并提取了安全性和有效性数据.使用汇总的结果案例来计算比值比（OR），并从符合条件的研究中合成汇总率。比较非激光和激光技术。还进行了旋转工具和激光提取的亚组比较。
结果：与激光相比，非激光手术死亡率较低（合并率0%vs0.1%，p<0.01),主要并发症(合并率为0.7%vs1.7%，p<0.01）和上腔静脉（SVC）损伤（合并率0%vs0.5%，p<0.001)，具有更高的完全成功率(合并率96.5%对93.8%，p<0.01)。与激光相比，非激光更有可能达到临床（OR2.16[1.77-2.63]，p<0.01)和完整(OR1.87[1.69-2.08]，p<0.01)成功，具有较低的手术死亡风险(OR1.6[1.02-2.5]，p<0.05)。在亚组分析中，与激光相比，旋转工具取得了更大的完全成功(合并率97.4%vs95%，p<0.01），SVC损伤较低（合并率0%vs0.7%，p<0.01)。
结论：与激光方法相比，非激光TLE具有更好的安全性和有效性。与激光鞘管拔出相关的SVC损伤的风险更大。
目的：我们试图在荟萃分析中比较非激光和激光TLE。
方法：我们搜索了Medline，Embase,Scopus,1991-2021年间发表的TLE研究的ClinicalTrials.gov和CENTRAL数据库。从纳入的68项研究中，我们仔细评估并提取了安全性和有效性数据.使用汇总的结果案例来计算比值比（OR），并从符合条件的研究中合成汇总率。比较非激光和激光技术。还进行了旋转工具和激光提取的亚组比较。
结果：与激光相比，非激光手术死亡率较低（合并率0%vs0.1%，p<0.01),主要并发症(合并率为0.7%vs1.7%，p<0.01）和上腔静脉（SVC）损伤（合并率0%vs0.5%，p<0.001)，具有更高的完全成功率(合并率96.5%对93.8%，p<0.01)。与激光相比，非激光更有可能达到临床（OR2.16[1.77-2.63]，p<0.01)和完整(OR1.87[1.69-2.08]，p<0.01)成功，具有较低的手术死亡风险(OR1.6[1.02-2.5]，p<0.05)。在亚组分析中，与激光相比，旋转工具取得了更大的完全成功(合并率97.4%vs95%，p<0.01），SVC损伤较低（合并率0%vs0.7%，p<0.01)。
结论：与激光方法相比，非激光TLE具有更好的安全性和有效性。与激光鞘管拔出相关的SVC损伤的风险更大。
