Interdisciplinary stepwise approach for an effective and safe Mechanical Transvenous Lead Extraction
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Abstract
Aims: Mechanical force applied during leads removal is the main cause for major complications and cardiovascular injuries. Aim of this study was to retrospectively analyse safety and effectiveness of a stepwise interdisciplinary approach for mechanical transvenous lead extraction.
Methods: From February 2011 to December 2017, 71 patients (pts) underwent electronic leads extraction for Cardiac Implantable Electronic Devices (CIED) complications. Mean age was 70±11 years (range 34-92). A total of 160 leads were managed with a mean time from implantation to extraction of 33±39 months (range 4-300). Lead type were atrial (37%), Ventricular (49%) and Coronary sinus (14%). Indication for lead removal were pocket/lead erosion (73%), isolated lead infection (10%), dysfunction or upgrading (17%), respectively. Data on algorithm of treatment, procedural success, complications as well as 30 day mortality are reported.
Results: There were 152 leads extracted (95%) for a complete procedural success (CPS) in 90%, clinical success (CS) in 8.5%, and failure in 1.5% of pts, respectively. Associated procedures were aortic valve replacement (AVR) in 1 pt and AVR plus tricuspid valve repair in 1 pt. No major complications or cardiovascular injuries were detected whereas hemopericardium was reported in 2 pts and pocket bleeding in 1 pt, respectively. There were 3 in-hospital deaths (4.2%), but no one of them were procedure-related.
Conclusion: In our clinical experience we demonstrated that mechanical transvenous lead extraction is a safe and effective procedure also in small volume center providing that an interdisciplinary heart-team stepwise approach is applied.
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