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Mizuno T, Goya M, Fujiwara T, Oishi K, Takeshita M, Yashima M, Nagaoka E, Oi K, Sasano T. Surgical extraction of cardiac implantable electronic device leads based on a heart team approach. J Cardiol 2023; 81:111-116. [PMID: 36229301 DOI: 10.1016/j.jjcc.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND As cardiac implantable electronic devices, such as pacemakers, cardioverter defibrillators, and cardiac resynchronization therapies, have become more popular, device extraction has become more frequent. At our institution, individual treatment strategies are discussed at a heart team meeting. Transvenous lead extraction (TVLE) is a first-line treatment; however, surgical lead extraction (SLE) is sometimes selected as a primary choice to provide optimal treatment and maintain the medical safety policy. This study aimed to investigate the validity of this heart team decision-making. METHODS From 2013 to 2021, 384 consecutive patients underwent lead extraction at our institution. RESULTS SLE was proposed as the primary intervention for 21 patients who had high risk of bleeding, difficult TVLE conditions, large vegetations, and other concomitant cardiac diseases. Of the 363 TVLE patients, 10 patients required surgical intervention; 5 had TVLE difficulty followed by SLE and 5 had excessive bleeding. SLE was performed in 26 patients, 19 of whom required valve surgery, and 8 required plication of the great veins. In 4 of the 17 hybrid procedures with SLE and TVLE, excessive bleeding occurred due to laceration of the superior vena cava and innominate vein. Operative mortality was not observed in SLE patients but was observed in 1 of the 4 TVLE patients who required emergent open-chest hemostasis. CONCLUSIONS The heart team discussion was essential to provide optimal treatment and maintain medical safety policies for each patient. SLE should be selected for patients with high risk of TVLE or other cardiac complications such as tricuspid valve incompetence.
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Affiliation(s)
- Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan; Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
| | - Masahiko Goya
- Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyotoshi Oishi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Takeshita
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Yashima
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Oi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Arrhythmia Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Volk L, Verghis N, Ikegami H, Takebe M, Russo MJ, Lee LY, Lemaire A. Is cardiopulmonary bypass standby still required for laser lead extractions? J Cardiothorac Surg 2022; 17:235. [PMID: 36109812 PMCID: PMC9476252 DOI: 10.1186/s13019-022-01987-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Over the last two decades there has been an increase in the number of cardiac implantable electronic devices and consequently, there has also been an increased need for lead extractions. Fibrotic attachments develop between the lead and the venous and cardiac structures that may require the use of a laser to mobilize the lead. Cardiothoracic surgeons (CTS) have traditionally provided backup for surgical emergencies for these extractions. This study evaluates the surgical outcomes of patients undergoing transvenous laser lead extractions (TLE) and determines if CTS are still needed for backup. Methods A retrospective review of consecutive patients undergoing laser lead extractions at a single academic center. Lead extractions using only laser sheaths were analyzed. The clinical characteristics, complications, and mortality of the patients were evaluated. Results One hundred and twenty-one patients underwent TLEs from January 1st, 2014 to December 31st, 2018. The majority were male (N = 80, 66.1%), and the average age was 66.48 ± 14 years. The indication for removal was either laser lead malfunction or infection. A total of 30 patients (24.8%) had complications postoperatively including wound hematomas, superficial infections, and arrhythmias. The average length of stay was 9 ± 12 for all the patients in the study. 2 patients (1.6%) had injuries that required emergency surgical repair with injuries to the posterior superior vena cava and right ventricle. Both patients survived the initial injury with one patient was discharged home on day 4 and the other succumbing to his injuries on postoperative day 20. Conclusion Although the incidence of surgical emergencies is rare the morbidity and mortality for TLE require that surgical backup be available.
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Ahmed A, Arabia G, Bontempi L, Cerini M, Salghetti F, Muneretto C, Mitacchione G, Milidoni A, Curnis A. Hybrid transvenous and surgical approach for the extraction of coronary sinus leads: A case series. Pacing Clin Electrophysiol 2022; 45:861-865. [PMID: 35596733 PMCID: PMC9541447 DOI: 10.1111/pace.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/14/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
Background Transvenous lead extraction is the standard therapy for cardiac device‐related infection. In some patients, however, a hybrid surgical and transvenous approach may be necessary. Methods and Results We present three cases who underwent transvenous lead extraction for an infected CRT‐D system. In all cases the CS lead could not be retrieved transvenously due to extensive fibrosis. The lead was successfully extracted through left minithoracotomy in two patients and midline sternotomy in one patient. Conclusion In cases where the coronary sinus lead shows severe fibrosis, a transvenous approach can be used to free the proximal part of the lead, while the distal adhesions can be removed surgically through a limited thoracic incision.
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Affiliation(s)
- Ashraf Ahmed
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.,Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Gianmarco Arabia
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Luca Bontempi
- Department of Cardiology, Asst Bergamo Est, Bolognini Hospital, Seriate, Bergamo, Italy
| | - Manuel Cerini
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Salghetti
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Claudio Muneretto
- Department of Cardiac Surgery, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Gianfranco Mitacchione
- Department of Cardiology, Asst-Fatebenefratelli Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Antonino Milidoni
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Antonio Curnis
- Cardio-Thoracic Department, Electrophysiology and Electrostimulation Laboratory, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
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GÖÇER K, YILDIRIMDEMİR H. Kardiyak Tamponad ile Başvuran Çok Geç ve Subakut Sağ Ventriküler Lead Perforasyonu Olgu Sunumu. ACTA MEDICA ALANYA 2021. [DOI: 10.30565/medalanya.893608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Migliore F, Tarzia V, Dall'Aglio PB, Falzone PV, De Lazzari M, Bottio T, D'Onofrio A, Padalino M, Vida V, Rosso J, Leoni L, Pittarello D, Bertaglia E, Iliceto S, Gerosa G. The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction. Pacing Clin Electrophysiol 2021; 45:92-102. [PMID: 34699079 DOI: 10.1111/pace.14396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/23/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies have shown that Evolution RL bidirectional rotational mechanical sheath (Cook Medical,USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary approach highlighting the value of a joint cardiac surgeon and electrophysiologist collaboration. METHODS The study population comprised 84 patients (77%male;mean age 65±18 years) undergoing TLE.After multidisciplinary evaluation, a combined procedure was considered. RESULTS The main indication for TLE was infection in 54 cases (64%).Overall,152 leads were extracted with a mean implant duration of 94±63 months (range 12-421).Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 91.6 % (77/84),97.6% (82/84), and 98.6%(150/152), respectively.Eighteen combined procedure were performed in 12 patients (14%), such as "hybrid approach" (n = 2) or TLE concomitant to:1) transcatheter aspiration procedure for large vegetation (n = 8); 2) left ventricular assistance device implantation as bridge to cardiac transplantation (n = 1); 3) permanent pacing with epicardial leads (n = 6); 4) tricuspid valve replacement (n = 1).One major complication (1.2%) and 11 (13%) minor complications were encountered.No injury to the superior vena cava occurred and no procedure-related deaths were reported. During a mean time follow-up of 21±18 months, 17 patients (20%) died.They were more often diabetics (P = 0.02), and they underwent TLE more often for infection (P = 0.004). CONCLUSIONS Our results support the finding that excellent outcomes can be achieved in performing TLE of chronically implanted leads by using the Evolution RL bidirectional rotational mechanical sheath and a multidisciplinary team approach involving both electrophysiologist and cardiac surgeon as first line operators. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Vincenzo Tarzia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Pasquale Valerio Falzone
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Massimo Padalino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Vladimiro Vida
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Jacopo Rosso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Loira Leoni
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Demetrio Pittarello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
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Wacker M, Thewes L, Lux A, Busk H, Zardo P, Scherner M, Awad G, Varghese S, Veluswamy P, Wippermann J, Slottosch I. Monitoring excimer laser-guided cardiac lead extractions by uniportal video-assisted thoracoscopy: A single center experience. Asian Cardiovasc Thorac Ann 2021; 30:561-566. [PMID: 34693749 DOI: 10.1177/02184923211054883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Though laser guided extractions of cardiac implantable electronic devices leads have become a routine procedure, the severe complications are associated with a high mortality. Here, we report our single center experience using uniportal video-assisted thoracoscopy for laser lead extraction and compare it to stand-alone laser lead extraction. METHODS The intraoperative data and postoperative clinical outcomes of patients undergoing laser lead extraction with concomitant thoracoscopy (N = 28) or without (N = 43) in our institution were analyzed retrospectively. RESULTS Neither the median x-ray time (612.0 s for the thoracoscopy group vs. 495.5 s for the non-thoracoscopy group, p = 0.962), length of the operation (112.5 vs. 100.0 min, p = 0.676) or the median length of hospital stay (9.0 vs. 10.0 days, p = 0.990) differed significantly. The mean intensive care unit stay was longer for patients in the non-thoracoscopy group (0.8 vs. 2.5 days, p = 0.005). The 30-day-mortality in the thoracoscopy group was zero, whereas five patients died in the non-thoracoscopy group. Furthermore, four patients in the non-thoracoscopy group had encountered haemothorax, while none were observed in the thoracoscopy group (p = 0.148). CONCLUSIONS The adoption of uniportal video-assisted thoracoscopy during laser-guided lead extraction of cardiac implantable electronic devices can be considered safe and does not lengthen the operating time or hospital stay. It might be useful in the detection of severe complications and, in experienced hands, possibly allow direct bleeding control.
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Affiliation(s)
- Max Wacker
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Lena Thewes
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Henning Busk
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Patrick Zardo
- Department of Cardiothoracic, Transplantation and Vascular Surgery, 9177Hannover Medical School, Hannover, Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - George Awad
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Sam Varghese
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Priya Veluswamy
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery, 39067University Hospital Magdeburg, Magdeburg, Germany
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Contractor T, Kheiwa A, Mandapati R, Buch E, M Cooper J, Martens T. Lead extraction and upgrade to a biventricular device with concomitant systemic tricuspid valve replacement in an adult with congenitally corrected transposition: A hybrid approach. HeartRhythm Case Rep 2020; 6:511-515. [PMID: 32817830 PMCID: PMC7424290 DOI: 10.1016/j.hrcr.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Tahmeed Contractor
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Ahmed Kheiwa
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Ravi Mandapati
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joshua M Cooper
- Section of Cardiac Electrophysiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Timothy Martens
- Department of Cardiac Surgery, Loma Linda University Medical Center, Loma Linda, California
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