Hybrid minimally invasive technique with the bidirectional rotational Evolution® mechanical sheath for transvenous lead extraction: A collaboration between electrophysiologists and cardiac surgeons

Figures

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  Figure 1. Preoperative chest X‐ray showing double coil right ventricular lead (black line), passive‐fixation atrial lead (dotted line), and coronary sinus lead (dashed line) (Panel A). Operatory view: device remove (black line) and preparation of the right anterior minithoracotomy for direct visualization of the critical area for potential vascular injury during transvenous lead extraction (Panel B). Intraoperative fluoroscopy view: Cook medical Evolution RL sheath tip (black line), steady outer sheath (dotted line), and transesophageal echocardiography (dashed line) (Panel C). Direct surgical view of lung (black line), superior vena cava (dotted line), and ascending aorta (dashed line) (Panel D)

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  Figure 2. Chest X‐ray after lead extraction showing a temporary right ventricular lead (black line) inserted via the right axillary vein, and the external pulse generator (dotted line) (Panel A). Right ventricular extracted lead. Of note, the presence of important fibrous material adherent to the lead (Panel B)