Key result
In a high-volume center experience of 3,207 transvenous lead extractions, procedural success was 96.1% and major complications occurred in 1.9%, with emergency cardiac surgery required in 1.18% of patients.
Why the study?
Guidelines emphasize the importance of cardiac surgery in managing life-threatening complications of lead removal, prompting this study to delineate the roles of the cardiac surgeon during transvenous lead extraction.
Observational (n=3,207)
Yes
Emergency cardiac surgery is required in approximately 1.2% of transvenous lead extractions, primarily for severe bleeding, highlighting the critical need for close collaboration between electrophysiologists and cardiac surgeons.
Supports surgical backup protocols in lead extraction programs; leaves open optimal strategies to further reduce rescue rates.
Introduction: The guidelines stress the importance of cardiac surgery in the management of life-threatening complications arising from lead removal. Aim: To delineate the roles of the cardiac surgeon during transvenous lead extraction (TLE). Material and methods: 3207 patients (38.7% F), average age 65.7 years, underwent the extraction of PM/ICD leads using standard non-powered mechanical systems within the last 14 years. Results: Procedural success 96.1%, clinical success 97.8%, procedure-related death 0.18%, major complications 1.9% (cardiac tamponade 1.2%, hemothorax 0.2%, tricuspid valve damage 0.3%, stroke and pulmonary embolism < 1%). The roles for cardiac surgery in TLE have been categorized into five areas: 1. Emergency cardiac surgery (1.18% of all patients), 2. Late surgical intervention (TLE-related tricuspid valve dysfunction) (0.44%), 3. Cardiac surgery complementing partially successful TLE (0.68%: removal of lead fragments), 4. Epicardial pacemaker implantation through sternotomy for the above-mentioned reasons (0.65%), 5. Delayed surgical intervention after TLE to place epicardial LV leads (0.53%). Additionally, surgical experience can help in prevention and treatment of wound infection after TLE. Conclusions: Emergency cardiac surgery (mainly due to severe bleeding) is still the most frequent reason for intervention (33.63% (38/113) of all surgical procedures). The other areas of surgical interventions in lead management are: cardiac surgery complementing partially successful TLE, repair or replacement of the malfunctioning tricuspid valve secondary to lead extraction and implantation of permanent epicardial pacing leads after sternotomy or epicardial left ventricle lead to optimize cardiac resynchronization. Experience of a single high-volume lead extraction center confirms the need for close collaboration between the cardiologist and the cardiac surgeon, whose role goes far beyond mere surgical standby.
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Tułecki et al. (2022) conducted an observational in Patients requiring transvenous lead extraction of pacemaker or ICD leads (n=3,207). Transvenous lead extraction (TLE) was evaluated on Procedural success. In a high-volume center experience of 3,207 transvenous lead extractions, procedural success was 96.1% and major complications occurred in 1.9%, with emergency cardiac surgery required in 1.18% of patients.
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