Key result
Balloon aortic valvuloplasty prior to lead extraction can be performed to reduce stenosis severity in patients with device infection when valve replacement is not feasible.
Case Report
In patients with ICD infection and severe aortic stenosis where valve replacement is not feasible, balloon aortic valvuloplasty prior to lead extraction can be performed to reduce stenosis severity.
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May enable lead extraction in select ICD infection cases with inoperable aortic stenosis; hypothesis-generating and should not yet change practice.
Key Teaching Points•Severe aortic stenosis can increase the risk of a lead extraction procedure owing to blood pressure fluctuations during the procedure from vagal effects, venotomy site bleeding, temporary right ventricular inversion during lead traction, and a risk of vascular or cardiac perforation.•When valve replacement is not a feasible option, such as in the setting of device infection, balloon aortic valvuloplasty prior to lead extraction can be performed to reduce the severity of stenosis.•A multidisciplinary team approach that includes an electrophysiologist, cardiac surgeon, echocardiography specialist, structural cardiologist, and cardiac anesthesiologist is essential to perform safe and effective lead extraction in high-risk patients. •Severe aortic stenosis can increase the risk of a lead extraction procedure owing to blood pressure fluctuations during the procedure from vagal effects, venotomy site bleeding, temporary right ventricular inversion during lead traction, and a risk of vascular or cardiac perforation.•When valve replacement is not a feasible option, such as in the setting of device infection, balloon aortic valvuloplasty prior to lead extraction can be performed to reduce the severity of stenosis.•A multidisciplinary team approach that includes an electrophysiologist, cardiac surgeon, echocardiography specialist, structural cardiologist, and cardiac anesthesiologist is essential to perform safe and effective lead extraction in high-risk patients.
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Contractor et al. (2019) conducted a case report in Implantable cardioverter-defibrillator infection and severe aortic stenosis. Balloon aortic valvuloplasty prior to lead extraction was evaluated. Balloon aortic valvuloplasty prior to lead extraction can be performed to reduce stenosis severity in patients with device infection when valve replacement is not feasible.
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