Key result
Preoperative transesophageal echocardiographic findings of vegetations were associated with increased long-term mortality after transvenous lead extraction (HR 2.631; 95% CI 1.738-3.983; P<0.001).
Why the study?
Pre-operative TEE frequently reveals lead-related abnormalities in patients referred for TLE, but whether these findings influence long-term prognosis was unknown.
Do specific preoperative transesophageal echocardiography findings predict long-term mortality in patients undergoing transvenous lead extraction?
Cohort (n=936)
No
Do specific preoperative transesophageal echocardiography findings predict long-term mortality in patients undergoing transvenous lead extraction?
Hazard Ratio: 2.631 (95% CI 1.738–3.983)
p-value: p=<0.001
Preoperative TEE findings, specifically vegetations and fibrous tissue binding sites, provide significant prognostic information regarding long-term survival in patients undergoing transvenous lead extraction.
Vegetations on preoperative TEE were associated with higher post-TLE mortality; hypothesis-generating for risk stratification, requiring prospective validation.
(1) Background: In patients referred for transvenous lead extraction (TLE) transesophageal echocardiography (TEE) often reveals abnormalities related to chronically indwelling endocardial leads. The purpose of this study was to determine whether the results of pre-operative TEE might influence the long-term prognosis. (2) Methods: We analyzed data from 936 TEE examinations performed at a high volume center in patients referred for TLE from 2015 to 2019. The follow-up was 566.2 ± 224.5 days. (3) Results: Multivariate analysis of TEE parameters showed that vegetations (HR = 2.631 [1.738–3.983]; p < 0.001) and tricuspid valve (TV) dysfunction unrelated to the endocardial lead (HR = 1.481 [1.261–1.740]; p < 0.001) were associated with increased risk for long-term mortality. Presence of fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.285; p = 0.035), presence of penetration or perforation of the lead through the cardiac wall up to the epicardium (HR = 0.496; p = 0.035) and presence of excessive lead loops (HR = 0.528; p = 0.026) showed a better prognosis. After adjustment the statistical model with recognized poor prognosis factors only vegetations were confirmed as a risk factor (HR = 2.613; p = 0.039). A better prognosis was observed in patients with fibrous tissue binding sites between the lead and the superior vena cava (SVC) and/or right atrium (RA) wall (HR = 0.270; p = 0.040). (4) Conclusions: Non-modifiable factors may have a negative influence on long-term survival after TLE. Various forms of connective tissue overgrowth and abnormal course of the leads modifiable by TLE can be a factor of better prognosis after TLE.
No takes yet. Share an insight, caveat, or question.
Nowosielecka et al. (2021) conducted a cohort in Transvenous lead extraction (n=936). Preoperative transesophageal echocardiographic findings (e.g., vegetations) vs. Absence of specific echocardiographic findings was evaluated on Long-term mortality (HR 2.631, 95% CI 1.738-3.983, p=<0.001). Preoperative transesophageal echocardiographic findings of vegetations were associated with increased long-term mortality after transvenous lead extraction (HR 2.631; 95% CI 1.738-3.983; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: