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Lin AY, Torriani F, Sung K, Trefethen E, Near N, Ho G, Pollema T, Birgersdotter-Green U. Automated electronic alert for the detection of infected cardiovascular implantable electronic devices in patients with bacteremia. Heart Rhythm 2024:S1547-5271(24)00223-6. [PMID: 38428447 DOI: 10.1016/j.hrthm.2024.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California, San Diego, La Jolla, California.
| | - Francesca Torriani
- Division of Infectious Disease, University of California, San Diego, La Jolla, California
| | - Kevin Sung
- Division of Cardiology, University of California, San Diego, La Jolla, California
| | - Emily Trefethen
- Division of Cardiology, University of California, San Diego, La Jolla, California
| | - Nicholas Near
- Division of Cardiology, University of California, San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, University of California, San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
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Afshar K, Schonhoft E, Kozuch J, Kafi A, Yung G, Pollema T, Golts E, Aslam S. Using HCV-viremic organs for lung transplantation does not confer higher rejection rates compared to HCV-negative organs. Clin Transplant 2024; 38:e15260. [PMID: 38369851 DOI: 10.1111/ctr.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND National data demonstrate that hepatitis C virus (HCV)-infected organ donors are increasingly being used in the US, including for lung transplantation. We aimed to assess whether there were any differences in the acute or chronic rejection rates at 1 year following lung transplantation from HCV-viremic versus uninfected donors. METHODS We retrospectively reviewed all lung transplant recipients at our institution from April 1, 2017 to October 1, 2020 and then assessed various outcomes between those who received a transplant from HCV-viremic donors versus HCV-negative donors. Primary outcome was to determine if there was a higher incidence of acute and/or chronic allograft rejection when using HCV NAT+ lung donation. We carried out univariate and multivariate analyses. RESULTS We transplanted 135 patients during the study period, including 18 from HCV-viremic donors. Standard induction therapy with basiliximab and maintenance triple drug immunosuppression was utilized per UC San Diego protocol. All 17 patients receiving HCV-viremic organs developed acute HCV infection and were treated in the postoperative period with 12 weeks of direct acting antivirals (DAA). HCV genotypes included 1, 2, and 3. DAA used included glecaprevir/pibrentasvir (12), sofosbuvir/velpatasvir (1), and ledipasvir/sofosbuvir (2) with drug choice determined by patient's medical insurance coverage. Sustained virological response at 12 weeks after end of DAA therapy (SVR12), indicative of a cure, was achieved in all (100%) recipients. No recipient had a serious adverse event related to HCV infection. The lung transplant recipient (LTR) HCV-viremic donors had lower rates of clinically significant rejection (5.9% vs. 11% LTR HCV-nonviremic donors), and no chronic lung allograft dysfunction at 1 year (vs. 5.9% LTR HCV-nonviremic donors). One-year survival was 100% in the LTR HCV-viremic donors compared to 95.8% in the LTR HCV-nonviremic donors. CONCLUSIONS We demonstrate the feasibility and success of using HCV NAT + donors with excellent results and without a higher incidence of rejection. Longer term follow-up and a larger sample size are needed to allow this to be a more widely accepted practice for lung transplant programs and payors.
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Affiliation(s)
- Kamyar Afshar
- Clinical Professor of Medicine, Medical Director, UC San Diego Lung Transplant Program, La Jolla, USA
| | - Elizabeth Schonhoft
- Clinical Professor of Medicine, Medical Director, UC San Diego Lung Transplant Program, La Jolla, USA
| | - Jade Kozuch
- Clinical Professor of Medicine, Medical Director, UC San Diego Lung Transplant Program, La Jolla, USA
| | - Aarya Kafi
- Clinical Professor of Medicine, Medical Director, UC San Diego Lung Transplant Program, La Jolla, USA
| | - Gordon Yung
- Clinical Professor of Medicine, Medical Director, UC San Diego Lung Transplant Program, La Jolla, USA
| | - Travis Pollema
- Clinical Professor of Medicine, Medical Director, UC San Diego Lung Transplant Program, La Jolla, USA
| | - Eugene Golts
- Clinical Professor of Medicine, Medical Director, UC San Diego Lung Transplant Program, La Jolla, USA
| | - Saima Aslam
- Clinical Professor of Medicine, Medical Director, UC San Diego Lung Transplant Program, La Jolla, USA
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Odish MF, Garimella PS, Crisostomo H, Yi C, Owens RL, Pollema T. Using Cardiohelp, Quadrox, and Nautilus Extracorporeal Membrane Oxygenators as Vascular Access for Hemodialysis, Continuous Renal Replacement Therapy, and Plasmapheresis: A Brief Technical Report. ASAIO J 2023; 69:e455-e459. [PMID: 37399278 PMCID: PMC10602218 DOI: 10.1097/mat.0000000000002005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
The use of intermittent hemodialysis (iHD), and continuous renal replacement therapy (CRRT), along with extracorporeal membrane oxygenation (ECMO) in patients with acute kidney injury (AKI) and end-stage renal disease (ESRD) is very common. In this technical report, we describe the methods to perform these dialytic therapies safely and effectively using the ECMO circuit in lieu of a separate dialysis catheter. Specifically, we describe in detail how to connect these kidney replacement therapy modalities to a Quadrox, Nautilus, and Cardiohelp HLS (combined oxygenator and pump) oxygenator. The dialysis (iHD or CRRT) inlet is attached to the post-oxygenators Luer-Lock, whereas the return is attached to the pre-oxygenator Luer-Lock, both with a dual lumen pigtail. We also discuss the technical aspects of performing plasmapheresis in conjunction with ECMO and iHD or CRRT. Finally, we highlight the fact that the reported technique does not require modifying the ECMO cannulas/tubing which helps maximize safety.
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Affiliation(s)
- Mazen F. Odish
- From the Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, UC San Diego Department of Medicine, La Jolla, California
| | - Pranav S. Garimella
- Division of Nephrology-Hypertension, UC San Diego Department of Medicine, La Jolla, California
| | | | - Cassia Yi
- UC San Diego Health Department of Nursing, La Jolla, California
| | - Robert L. Owens
- From the Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, UC San Diego Department of Medicine, La Jolla, California
| | - Travis Pollema
- Division of Cardiovascular and Thoracic Surgery, UC San Diego Department of Surgery, La Jolla, California
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Odish MF, Owens RL, Yi C, Golts E, Pollema T. Fractured Right Atrial-Pulmonary Artery Cannula (ProtekDuo) in a 164-Day Extracorporeal Membrane Oxygenation Bridge to Lung Transplant. ASAIO J 2023; 69:e401-e402. [PMID: 36538927 DOI: 10.1097/mat.0000000000001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Mazen F Odish
- From the Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego Health
| | - Robert L Owens
- From the Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego Health
| | - Cassia Yi
- Department of Nursing, UC San Diego Health
| | - Eugene Golts
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, UC San Diego Health
| | - Travis Pollema
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, UC San Diego Health
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Hernandez M, Puerta C, Thareja N, Zhang Y, Pollema T, Thistlethwaite P. Surgical management of left bundle branch pacing lead causing septal and left ventricular perforation. HeartRhythm Case Rep 2023; 9:520-523. [PMID: 37614392 PMCID: PMC10444550 DOI: 10.1016/j.hrcr.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/07/2023] [Accepted: 05/05/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Moises Hernandez
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
| | - Cristian Puerta
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
| | - Nikita Thareja
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
| | - Yu Zhang
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
| | - Patricia Thistlethwaite
- Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, California
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Lin A, Torriani F, Sung K, Trefethen E, Near N, Pollema T, Birgersdotter-Green U. AUTOMATED ELECTRONIC ALERTS FOR DETECTION OF INFECTED CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICE IN PATIENTS WITH BACTEREMIA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Patel K, Toomu S, Jacobs K, Pollema T, Ho G, Birgersdotter-Green U. VENOUS OCCLUSION DETECTED BY COMPUTED TOMOGRAPHY IS ASSOCIATED WITH TRANSVENOUS LEAD EXTRACTION DIFFICULTY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Odish M, Pollema T, Meier A, Hepokoski M, Yi C, Spragg R, Patel HH, Alexander LEC, Sun XS, Jain S, Simonson TS, Malhotra A, Owens RL. Very Low Driving-Pressure Ventilation in Patients With COVID-19 Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation: A Physiologic Study. J Cardiothorac Vasc Anesth 2023; 37:423-431. [PMID: 36567221 PMCID: PMC9701579 DOI: 10.1053/j.jvca.2022.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/01/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine in patients with acute respiratory distress syndrome (ARDS) on venovenous extracorporeal membrane oxygenation (VV ECMO) whether reducing driving pressure (ΔP) would decrease plasma biomarkers of inflammation and lung injury (interleukin-6 [IL-6], IL-8, and the soluble receptor for advanced glycation end-products sRAGE). DESIGN A single-center prospective physiologic study. SETTING At a single university medical center. PARTICIPANTS Adult patients with severe COVID-19 ARDS on VV ECMO. INTERVENTIONS Participants on VV ECMO had the following biomarkers measured: (1) pre-ECMO with low-tidal-volume ventilation (LTVV), (2) post-ECMO with LTVV, (3) during low-driving-pressure ventilation (LDPV), (4) after 2 hours of very low driving-pressure ventilation (V-LDPV, main intervention ΔP = 1 cmH2O), and (5) 2 hours after returning to LDPV. MAIN MEASUREMENTS AND RESULTS Twenty-six participants were enrolled; 21 underwent V-LDPV. There was no significant change in IL-6, IL-8, and sRAGE from LDPV to V-LDPV and from V-LDPV to LDPV. Only participants (9 of 21) with nonspontaneous breaths had significant change (p < 0.001) in their tidal volumes (Vt) (mean ± SD), 1.9 ± 0.5, 0.1 ± 0.2, and 2.0 ± 0.7 mL/kg predicted body weight (PBW). Participants with spontaneous breathing, Vt were unchanged-4.5 ± 3.1, 4.7 ± 3.1, and 5.6 ± 2.9 mL/kg PBW (p = 0.481 and p = 0.065, respectively). There was no relationship found when accounting for Vt changes and biomarkers. CONCLUSIONS Biomarkers did not significantly change with decreased ΔPs or Vt changes during the first 24 hours post-ECMO. Despite deep sedation, reductions in Vt during V-LDPV were not reliably achieved due to spontaneous breaths. Thus, patients on VV ECMO for ARDS may have higher Vt (ie, transpulmonary pressure) than desired despite low ΔPs or Vt.
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Affiliation(s)
- Mazen Odish
- UC San Diego Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, La Jolla, CA.
| | - Travis Pollema
- UC San Diego Department of Surgery, Division of Cardiovascular and Thoracic Surgery, La Jolla, CA
| | - Angela Meier
- UC San Diego Department of Anesthesiology, Division of Critical Care, La Jolla, CA
| | - Mark Hepokoski
- UC San Diego Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, La Jolla, CA; VA San Diego Healthcare System, Pulmonary Critical Care Section, San Diego, CA
| | - Cassia Yi
- UC San Diego Health Department of Nursing, La Jolla, CA
| | - Roger Spragg
- UC San Diego Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, La Jolla, CA
| | - Hemal H Patel
- UC San Diego Department of Anesthesiology, Division of Critical Care, La Jolla, CA; VA San Diego Healthcare System, Pulmonary Critical Care Section, San Diego, CA
| | - Laura E Crotty Alexander
- UC San Diego Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, La Jolla, CA; VA San Diego Healthcare System, Pulmonary Critical Care Section, San Diego, CA
| | - Xiaoying Shelly Sun
- UC San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA
| | - Sonia Jain
- UC San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA
| | - Tatum S Simonson
- UC San Diego Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, La Jolla, CA
| | - Atul Malhotra
- UC San Diego Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, La Jolla, CA
| | - Robert L Owens
- UC San Diego Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, La Jolla, CA
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Birs A, Darden D, Eskander M, Pollema T, Ho G, Birgersdotter-Green U. Implantable loop recorder as a strategy following cardiovascular implantable electronic device extraction without reimplantation. Pacing Clin Electrophysiol 2022; 45:853-860. [PMID: 35587876 DOI: 10.1111/pace.14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/29/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited data exists for outcomes in patients undergoing cardiovascular implantable electronic device (CIED) transvenous lead extraction (TLE) without clear indications for device reimplantation. The implantable loop recorder (ILR) may be an effective strategy for continuous monitoring in select individuals. OBJECTIVE This retrospective analysis aims to investigate patients who have undergone ILR implant following TLE without CIED reimplantation. METHODS Clinical data from consecutive patients who have undergone TLE with ILR implant and without CIED reimplantation from October 2016 to May 2020 at a single center were collected. RESULTS Among 380 patients undergoing TLE, 28 (7.7%) underwent ILR placement without CIED reimplantation. TLE indications were systemic infection (n = 13, 46.4%), pain at the site (n = 8, 28.6%), device/lead malfunction (n = 4, 14.2%), and other. Devices extracted included: dual-chamber and single-chamber pacemaker (n = 14, 50%; n = 4, 14.2%), dual-chamber implantable cardiac defibrillator (n = 10; 35.7%), and cardiac-resynchronization therapy with defibrillator (n = 1, 3.5%). Reasons for no reimplantation included no longer meeting CIED criteria (n = 14, 50%), patient preference (n = 9, 32.1%), and no clear or inappropriate indication for initial CIED implantation (n = 5, 18%). During an average of 12.3 ± 13.1 months of follow-up, there were no lethal arrhythmias, and 4 (13.3%) patients underwent permanent pacemaker reimplantation due to symptomatic sinus bradycardia and atrioventricular block with syncope as discovered on ILR. Three patients died due to unknown causes (n = 1), non-cardiac (n = 1), and acute coronary syndrome (n = 1). CONCLUSIONS In patients undergoing TLE without reimplantation, an ILR may be an effective monitoring strategy in patients at low risk for cardiac arrhythmia. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Antoinette Birs
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Douglas Darden
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Michael Eskander
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Travis Pollema
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Gordon Ho
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
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Patel K, Munir MB, Darden D, Bhatia P, Jacobs K, Pollema T, Birgersdotter-Green UM. CI-563-03 GENDER-BASED DIFFERENCES IN LEAD PERFORATION RATES ON COMPUTED TOMOGRAPHY SCANS IN PATIENTS UNDERGOING TRANSVENOUS LEAD EXTRACTION: RESULTS FROM UC SAN DIEGO LEAD EXTRACTION DATABASE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Green E, Dardan D, Pratt T, Pollema T. LEAD-ASSOCIATED ENDOCARDITIS IN A PATIENT WITH A PATENT FORAMEN OVALE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03447-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Darden D, Boateng BA, Tseng AS, Alshawabkeh L, Pollema T, Cha YM, Birgersdotter-Green U. Transvenous Laser Lead Extraction in Patients with Congenital Complete Heart Block. Heart Rhythm 2022; 19:1158-1164. [DOI: 10.1016/j.hrthm.2022.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
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13
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Moseley T, Birgersdotter-Green U, Feld G, Pollema T. Malignancies masquerading as device pocket infections. HeartRhythm Case Rep 2021; 7:694-697. [PMID: 34712568 PMCID: PMC8530908 DOI: 10.1016/j.hrcr.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Toni Moseley
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | | | - Gregory Feld
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
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Odish MF, Yi C, Chicotka S, Genovese B, Golts E, Madani M, Owens RL, Pollema T. Implementation and Outcomes of a Mobile Extracorporeal Membrane Oxygenation Program in the United States During the Coronavirus Disease 2019 Pandemic. J Cardiothorac Vasc Anesth 2021; 35:2869-2874. [PMID: 34176676 PMCID: PMC8152207 DOI: 10.1053/j.jvca.2021.05.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/02/2021] [Accepted: 05/21/2021] [Indexed: 01/19/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic began in the United States around March 2020. Because of limited access to extracorporeal membrane oxygenation (ECMO) in the authors' region, a mobile ECMO team was implemented by April 2020 to serve patients with COVID-19. Several logistical and operational needs were assessed and addressed to ensure a successful program, including credentialing, equipment management, and transportation. A multidisciplinary team was included in the planning, decision-making, and implementation of the mobile ECMO. From April 2020 to January 2021, mobile ECMO was provided to 22 patients in 13 facilities across four southern California counties. The survival to hospital discharge of patients with COVID-19 who received mobile ECMO was 52.4% (11 of 21) compared with 45.2% (14 of 31) for similar patients cannulated in-house. No significant patient or transportation complications occurred during mobile ECMO. Neither the ECMO nor transport teams experianced unprotected exposures to or infections with severe acute respiratory syndrome coronavirus 2. Herein, the implementation of the mobile ECMO team is reviewed, and patient characteristics and outcomes are described.
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Affiliation(s)
- Mazen F Odish
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, San Diego, CA.
| | - Cassia Yi
- Department of Nursing, University of California, San Diego, San Diego, CA
| | - Scott Chicotka
- Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, San Diego, CA
| | - Bradley Genovese
- Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, San Diego, CA
| | - Eugene Golts
- Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, San Diego, CA
| | - Michael Madani
- Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, San Diego, CA
| | - Robert L Owens
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, San Diego, CA
| | - Travis Pollema
- Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, San Diego, CA
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Odish M, Yi C, Eigner J, Kenner Brininger A, Koenig KL, Willms D, Lerum S, McCaul S, Boyd King A, Sutherland G, Cederquist L, Owens RL, Pollema T. The Southern California Extracorporeal Membrane Oxygenation Consortium During the Coronavirus Disease 2019 Pandemic. Disaster Med Public Health Prep 2021; 16:1-8. [PMID: 34099097 PMCID: PMC8314051 DOI: 10.1017/dmp.2021.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/10/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023]
Abstract
In March 2020, at the onset of the coronavirus disease 2019 (COVID-19) pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. The consortium included physicians and coordinators from the 4 ECMO centers in San Diego County. Guidelines were created to ensure that ECMO was delivered equitably and in a resource effective manner across the county during the pandemic. A biomedical ethicist reviewed the guidelines to ensure ECMO use would provide maximal community benefit of this limited resource. The San Diego County Health and Human Services Agency further incorporated the guidelines into its plans for the allocation of scarce resources. The consortium held weekly video conferences to review countywide ECMO capacity (including census and staffing), share data, and discuss clinical practices and difficult cases. Equipment exchanges between ECMO centers maximized regional capacity. From March 1 to November 30, 2020, consortium participants placed 97 patients on ECMO. No eligible patients were denied ECMO due to lack of resources or capacity. The Southern California ECMO Consortium may serve as a model for other communities seeking to optimize ECMO resources during the current COVID-19 or future pandemics.
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Affiliation(s)
- Mazen Odish
- University of California, San Diego Health, San Diego, California, USA
| | - Cassia Yi
- University of California, San Diego Health, San Diego, California, USA
| | | | | | - Kristi L. Koenig
- County of San Diego Health and Human Services Agency, San Diego, California, USA
| | | | - Suzan Lerum
- Sharp HealthCare, San Diego, California, USA
| | | | | | | | | | - Robert L. Owens
- University of California, San Diego Health, San Diego, California, USA
| | - Travis Pollema
- University of California, San Diego Health, San Diego, California, USA
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Lin AY, Saul T, Aldaas OM, Lupercio F, Ho G, Pollema T, Pretorius V, Birgersdotter-Green U. Early Versus Delayed Lead Extraction in Patients With Infected Cardiovascular Implantable Electronic Devices. JACC Clin Electrophysiol 2021; 7:755-763. [PMID: 33358664 PMCID: PMC8209117 DOI: 10.1016/j.jacep.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess the impact of early versus delayed lead extraction in patients with an infected cardiovascular implantable electronic device (CIED). BACKGROUND CIED infections are associated with poor outcomes. Prior studies have demonstrated improved survival with CIED extraction compared with antibiotic therapy alone. The impact of timing of CIED extraction has not been well characterized. METHODS All infected CIED extraction cases at our medical center from 2006 to 2019 were reviewed. Patients were divided into 2 groups based on the presence of bacteremia or isolated pocket infection. We assessed the in-hospital morbidity and 1-year mortality for early versus delayed lead extraction, using hospitalization day 7 as cutoff. RESULTS Of 233 patients who underwent CIED extraction, 127 patients had bacteremia and 106 patients had pocket infection. Delayed extraction (15.2 days) in bacteremic patients was associated with septic shock (odds ratio [OR]: 5.39; 95% confidence interval [CI]: 1.23 to 23.67; p = 0.026), acute kidney injury (OR: 5.61; 95% CI: 2.15 to 14.63; p < 0.001), respiratory failure (OR: 5.52; 95% CI: 1.25 to 24.41; p = 0.024), and decompensated heart failure (OR: 3.32; 95% CI: 1.10 to 10.05; p = 0.033). Locally infected patients with delayed extraction (10.7 days) were associated with acute kidney injury (OR: 3.45; 95% CI: 1.11 to 10.77; p = 0.033) and respiratory failure (OR: 10.29; 95% CI: 1.26 to 83.93; p = 0.030). Delayed CIED extraction in both groups was associated with increased 1-year mortality. CONCLUSIONS Delayed infected CIED extraction is associated with worse outcomes. This underscores the importance of early detection and a strategy for prompt management including lead extraction.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA.
| | - Tatiana Saul
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Omar M Aldaas
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Florentino Lupercio
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Gordon Ho
- Division of Cardiology, University of California-San Diego, La Jolla, California, USA
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California-San Diego, La Jolla, California, USA
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California-San Diego, La Jolla, California, USA
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17
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Odish MF, Yang J, Cheng G, Yi C, Golts E, Madani M, Pollema T, Owens RL. Treatment of Bronchopleural and Alveolopleural Fistulas in Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation, a Case Series and Literature Review. Crit Care Explor 2021; 3:e0393. [PMID: 34036268 PMCID: PMC8133109 DOI: 10.1097/cce.0000000000000393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To describe a ventilator and extracorporeal membrane oxygenation management strategy for patients with acute respiratory distress syndrome complicated by bronchopleural and alveolopleural fistula with air leaks. DESIGN SETTING AND PARTICIPANTS Case series from 2019 to 2020. Single tertiary referral center-University of California, San Diego. Four patients with various etiologies of acute respiratory distress syndrome, including influenza, methicillin-resistant Staphylococcus aureus pneumonia, e-cigarette or vaping product use-associated lung injury, and coronavirus disease 2019, complicated by bronchopleural and alveolopleural fistula and chest tubes with air leaks. MEASUREMENTS AND MAIN RESULTS Bronchopleural and alveolopleural fistula closure and survival to discharge. All four patients were placed on extracorporeal membrane oxygenation with ventilator settings even lower than Extracorporeal Life Support Organization guideline recommended ultraprotective lung ventilation. The patients bronchopleural and alveolopleural fistulas closed during extracorporeal membrane oxygenation and minimal ventilatory support. All four patients survived to discharge. CONCLUSIONS In patients with acute respiratory distress syndrome and bronchopleural and alveolopleural fistula with persistent air leaks, the use of extracorporeal membrane oxygenation to allow for even lower ventilator settings than ultraprotective lung ventilation is safe and feasible to mediate bronchopleural and alveolopleural fistula healing.
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Affiliation(s)
- Mazen F Odish
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego, La Jolla, CA
| | - Jenny Yang
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego, La Jolla, CA
| | - George Cheng
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego, La Jolla, CA
| | - Cassia Yi
- Department of Nursing, UC San Diego Health, La Jolla, CA
| | - Eugene Golts
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, UC San Diego, La Jolla, CA
| | - Michael Madani
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, UC San Diego, La Jolla, CA
| | - Travis Pollema
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, UC San Diego, La Jolla, CA
| | - Robert L Owens
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego, La Jolla, CA
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18
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Tseng A, Boateng BA, Darden D, Alshawabkeh L, Pollema T, Cha YM, Birgersdotter-Green U. TRANSVENOUS LEAD EXTRACTION IN ADULTS WITH CONGENITAL COMPLETE HEART BLOCK. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Lee CC, Pollema T, Birgersdotter-Green U. Early primary closure for device pocket infection. Pacing Clin Electrophysiol 2021; 44:763-764. [PMID: 33818811 DOI: 10.1111/pace.14234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/21/2021] [Accepted: 03/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Chin Chang Lee
- Division of Cardiology, Cardiac Electrophysiology Program, University of California Medical Center, San Diego, California, USA
| | - Travis Pollema
- Department of Cardiothoracic Surgery, Sulpizio Family Cardiovascular Center, La Jolla, CA, and the University of California Medical Center, San Diego, California, USA
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Cardiac Electrophysiology Program, University of California Medical Center, San Diego, California, USA
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20
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Bhatia P, Chiou T, Svennberg E, Khoche S, Jacobs K, Pollema T, Pretorius V, Birgersdotter-Green U. Clinical significance of incidentally detected lead perforations by computed tomography. Pacing Clin Electrophysiol 2021; 44:936-942. [PMID: 33786829 DOI: 10.1111/pace.14229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/24/2021] [Accepted: 03/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Computed tomography (CT) has an established role in detecting perforation of implanted pacemaker and defibrillator leads. The clinical significance of incidental finding of delayed lead perforation remains unclear. The aim of this study was to assess the prevalence of lead perforation as detected by CT in a cohort of patients undergoing transvenous laser lead extraction and characterize the association between finding of incidental lead perforation with periprocedural outcomes. METHODS Consecutive patients that underwent chest CT and lead extraction were retrospectively assessed for presence of lead perforation. A total of 143 patients and 348 leads were assessed. The finding of lead perforation was correlated with findings from peri-procedural transesophageal echocardiography (TEE) and outcomes of the lead extraction procedure. RESULTS Lead perforations (including perforations <5 mm and ≥5 mm) were detected in 66 (46%) patients and 73 (21%) leads. Lead perforation ≥5 mm were less common and detected in 13 (9%) of patients and 14 (4%) of leads. There was no significant difference in the rates of peri-procedural death, cardiac avulsion, cardiac tamponade or post-extraction pericardial effusion in patients with and without lead perforation. CONCLUSIONS Incidental delayed lead perforations detected by CT are common and do not correlate with significant TEE findings or adverse peri-procedural outcomes in patients undergoing lead extraction. Larger studies are needed to further characterize the frequency and safety of these findings.
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Affiliation(s)
- Prerana Bhatia
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Tommy Chiou
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Emma Svennberg
- Department of Medicine, Karolinska Institutet-Karolinksa University Hospital Huddinge, Stockholm, Sweden
| | - Swapnil Khoche
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Kathleen Jacobs
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California, USA
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California, USA
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California, USA
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21
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Shah K, Pollema T, Birgersdotter-Green U. Performance and outcomes of transvenous rotational lead extraction: Results from a prospective, monitored, global clinical study-"An evolution in extraction". Heart Rhythm O2 2021; 2:122-123. [PMID: 34115052 PMCID: PMC8183959 DOI: 10.1016/j.hroo.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Kunal Shah
- Division of Cardiology, Cardiac Electrophysiology Program, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
| | - Travis Pollema
- Division of Cardiothoracic surgery, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Cardiac Electrophysiology Program, Sulpizio Family Cardiovascular Center, La Jolla, California, and the University of California Medical Center, San Diego, California
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22
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Green EA, Pollema T, Pretorius V. A Case of CIED-Associated Endocarditis and Septic Emboli Requiring Lead Extraction, AngioVac Suction, and Pulmonary Endarterectomy. Cureus 2020; 12:e11601. [PMID: 33364121 PMCID: PMC7752741 DOI: 10.7759/cureus.11601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiac Implantable Electronic Devices (CIED)-associated infective endocarditis complicated by septic emboli and acute on chronic pulmonary hypertension is rare. We present a case where pulmonary thromboendarterectomy was required for treatment. A 55 year-old man with a history of myocardial infarction and ischemic cardiomyopathy status-post ICD placement 8 years prior presented with bacteremia, infected ICD, and tricuspid valve vegetation. He underwent CIED extraction along with the use of the AngioVac suction device to remove right ventricular and atrial vegetations. However the patient had persistent valvular vegetation and bilateral sub-massive pulmonary emboli. Pulmonary angiography showed filling defects in the lobar and segmental arteries. Percutaneous attempts at embolectomy were unsuccessful and he therefore underwent a pulmonary endarterectomy surgery (PTE). This case of CIED- associated endocarditis demonstrates the importance of early aggressive treatment of such infections. Guidelines recommend compete CIED system removal when there is associated infection. The AngioVac is a novel system for removal of right-sided vegetations and thrombi; however, complications such as distal embolization can occur. PTE surgery for septic emboli is rare. However, cases of such treatment as is presented here can be successful and may be necessary should percutaneous methods fail.
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Affiliation(s)
- Erik A Green
- Surgery, Tulane University School of Medicine, New Orleans, USA
| | - Travis Pollema
- Cardiothoracic Surgery, University of California San Diego School of Medicine, La Jolla, USA
| | - Victor Pretorius
- Cardiothoracic Surgery, University of California San Diego School of Medicine, La Jolla, USA
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23
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Cronin B, Guan P, Pollema T, Birgersdotter-Green U. A Dramatic Reduction in Left Ventricular Filling During Extraction of a Left Ventricle Lead. J Cardiothorac Vasc Anesth 2020; 35:1903-1905. [PMID: 33221153 DOI: 10.1053/j.jvca.2020.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Brett Cronin
- Clinical Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
| | - Patricia Guan
- Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Travis Pollema
- Department of Cardiothoracic Surgery, University of California, San Diego, San Diego, CA
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24
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Lin AY, Lupercio F, Ho G, Pollema T, Pretorius V, Birgersdotter-Green U. Safety and Efficacy of Cardiovascular Implantable Electronic Device Extraction in Elderly Patients: A Meta-Analysis and Systematic Review. Heart Rhythm O2 2020; 1:250-258. [PMID: 33604584 PMCID: PMC7889020 DOI: 10.1016/j.hroo.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Transvenous lead extraction of cardiovascular implantable electronic device (CIED) has been proven safe in the general patient population with the advances in extraction techniques. Octogenarians present a unique challenge given their comorbidities and the perceived increase in morbidity and mortality. Objective To assess the safety and outcomes of CIED extraction in octogenarians to younger patients. Methods We performed an extensive literature search and systematic review of studies that compared CIED extraction in octogenarians versus non-octogenarians. We separately assessed the rate of complete procedure success, clinical success, procedural mortality, major and minor complications. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used due to heterogeneity across study cohorts. Results Seven studies with a total of 4,182 patients were included. There was no difference between octogenarians and non-octogenarians in complete procedure success (RR 1.01, 95% CI 1.00 - 1.02, p = 0.19) and clinical success (RR 1.01, 95% CI 1.00 - 1.01, p = 0.13). There was also no difference in procedural mortality (RR 1.43, 95% CI 0.46 - 4.39, p = 0.54), major complication (RR 1.40, 95% CI 0.68 - 2.88, p = 0.36), and minor complication (RR 1.43, 95% CI 0.90 - 2.29, p = 0.13). Conclusion In this study, there was no evidence to suggest a difference in procedural success and complication rates between octogenarians and younger patients. Transvenous lead extraction can be performed safely and effectively in the elderly population.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Florentino Lupercio
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California
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25
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Cronin B, Danforth D, Pollema T, Maus T. Ventricular Pacing-Induced Tricuspid Regurgitation After Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2019; 34:851-853. [PMID: 31500978 DOI: 10.1053/j.jvca.2019.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Brett Cronin
- Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
| | - Dennis Danforth
- Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
| | - Travis Pollema
- Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
| | - Timothy Maus
- Department of Anesthesiology, University of California, San Diego, UCSD Medical Center, San Diego, CA
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26
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Ho G, Bhatia P, Mehta I, Maus T, Khoche S, Pollema T, Pretorius VG, Birgersdotter-Green U. Reply: Lead-Adherent Echodensities: The Rule Rather Than the Exception! JACC Clin Electrophysiol 2019; 5:868-869. [PMID: 31320019 PMCID: PMC9743974 DOI: 10.1016/j.jacep.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Gordon Ho
- Division of Cardiology- Electrophysiology, Department of
Medicine, University of California San Diego
| | - Prerana Bhatia
- Division of Cardiology- Electrophysiology, Department of
Medicine, University of California San Diego
| | - Ishan Mehta
- Division of Cardiology- Electrophysiology, Department of
Medicine, University of California San Diego
| | - Timothy Maus
- Department of Anesthesiology, University of California San
Diego
| | - Swapnil Khoche
- Department of Anesthesiology, University of California San
Diego
| | - Travis Pollema
- Division of Cardiothoracic Surgery, Department of Surgery,
University of California San Diego
| | - Victor Gert Pretorius
- Division of Cardiothoracic Surgery, Department of Surgery,
University of California San Diego
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27
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Ho G, Bhatia P, Mehta I, Maus T, Khoche S, Pollema T, Pretorius VG, Birgersdotter-Green U. Prevalence and Short-Term Clinical Outcome of Mobile Thrombi Detected on Transvenous Leads in Patients Undergoing Lead Extraction. JACC Clin Electrophysiol 2019; 5:657-664. [DOI: 10.1016/j.jacep.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 11/25/2022]
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Lewis K, Dai M, Patton KK, Cha YM, Pollema T, Feld GK, Birgersdotter-Green U, Pretorius V. Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device. Europace 2019; 21:781-786. [PMID: 30698694 DOI: 10.1093/europace/euy320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/20/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS Chronic pain at the cardiovascular implantable electronic device (CIED) generator or lead insertion site that is not otherwise manageable carries a IIA indication for extraction. However, limited data exist evaluating causes of pain and outcomes of extraction in eliminating pain. A multi-centre retrospective observational study was conducted to evaluate outcomes of patients undergoing device extraction for treatment of chronic device pain. METHODS AND RESULTS Twenty-seven out of 2188 lead extraction candidates (1.3%) met the chronic pain IIA indication for extraction [50 ± 16 years; 14 (51%) women]. Onset, severity, triggers, and pain management were measured before and after extraction. Device type, procedure done (with/without reimplantation), and positive tissue cultures were noted. Pain was reported as constant (n = 14; 50%), intermittent (n = 13; 46%), and movement-triggered (n = 14; 50%). Average severity of pain was seven out of 10 (10 being the worst). Post-extraction, 18 (66%) received freedom from pain, including all patients with poorly formed pockets (n = 2) and subclinical infections (n = 2). Of the 18, 11 underwent reimplantation (61%) without recurrent pain. Nine still had pain (44 ± 17 years; seven women) after extraction. Eight of the nine underwent reimplantation, three on the contralateral chest wall and five ipsilaterally. Pain severity decreased (n = 5), increased (n = 1), or was unchanged (n = 3). CONCLUSION Chronic pain at the CIED generator site can present as chronic or movement-triggered pain, and can be due to subclinical infection or a poorly formed device pocket. Extraction relieved constant and intermittent pain in two-thirds of patients. Extraction appears less successful in eliminating pain in women who undergo subsequent reimplantation.
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Affiliation(s)
- Kathryn Lewis
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
| | - Mingyan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, USA
| | - Kristen K Patton
- Division of Cardiology, University of Washington, 1959 NE Pacific St., Seattle, WA, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN, USA
| | - Travis Pollema
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
| | - Gregory K Feld
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
| | - Ulrika Birgersdotter-Green
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
| | - Victor Pretorius
- Department of Cardiac Electrophysiology, University of California, San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, USA
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29
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Khan F, Sverin G, Birgersdotter-Green U, Miller JP, Lalani G, Pollema T, Pretorius V. Risk of Collateral Lead Damage in Percutaneous Cardiac Implantable Electronic Device Extraction. JACC Clin Electrophysiol 2018; 4:193-200. [PMID: 29749937 DOI: 10.1016/j.jacep.2017.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to assess the risk of collateral lead damage during cardiac implantable electronic device extraction. BACKGROUND With the increasing numbers of cardiovascular implantable electronic devices, there has been an increase in the number of percutaneous device and lead extractions. It is unknown how often collateral damage (defined as the need for unintended lead extraction, or loss of lead's integrity or dislodgement) occurs in the planned retained leads. METHODS In this retrospective study, 108 patients who underwent incomplete cardiovascular implantable electronic device removal at the University of California, San Diego from September 2010 to September 2015 were included. The authors established the integrity of previously functioning leads at the end of each procedure as well as on follow-up visits using parameters including lead impedance change, threshold change, drop in P- or R-wave signal amplitude, or presence of lead noise. RESULTS Only 4 of 143 leads (2.7%) were found to have collateral damage. One right atrial (RA) lead had a clear insulation break, the second RA lead was found dislodged, and the third RA had a constant noise. The right ventricular lead was found to have a new high pacing threshold. Collateral lead age, extracted lead implantation site, collateral lead implantation site, and mode of lead extraction (laser, traction, or rotational dilator) did not have a significant correlation with the outcome of collateral lead damage. CONCLUSIONS Lead extraction can be performed safely; however, there is a small risk of damaging adjacent leads. Close follow-up is needed, especially for the first few months, to assess for the reconnected leads' integrity.
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Affiliation(s)
- Faris Khan
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California.
| | - Gustaf Sverin
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | - Ulrika Birgersdotter-Green
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | | | - Gautam Lalani
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Diego, School of Medicine, La Jolla, California
| | - Victor Pretorius
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Diego, School of Medicine, La Jolla, California
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30
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Khan F, Ahmed S, Humber D, Pollema T, Birgersdotter-Green U, Pretorius V. 61The incidence of bleeding complication associated with pacemaker and implantable cardioverter defibrillator lead extraction without reversal of anticoagulation. Europace 2017. [DOI: 10.1093/ehjci/eux133.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Kawata H, Green UB, Pollema T, Hsu J, Feld G, Pretorius V. P258Complications and success rates associated with extraction and reimplantation of coronary sinus leads in patients with cardiac resynchronization devices. Europace 2017. [DOI: 10.1093/ehjci/eux171.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Pollock J, Pollema T, Pretorius V, Birgersdotter-Green U, Cronin B. Percutaneous Laser Lead Extraction of an Inadvertently Placed Left-Sided Pacemaker Lead. J Cardiothorac Vasc Anesth 2017; 31:663-668. [DOI: 10.1053/j.jvca.2016.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Indexed: 11/11/2022]
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Khan F, Sverin G, Birgersdotter-Green U, Lalani G, Pollema T, Pretorius V. 136-58: Risk of Collateral Lead Damage in Percutaneous Cardiac Implantable Electronic Device Extraction. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hebsur S, Pollema T, Birgersdotter-Green U, Pretorius V. Extraction of a CardioFix neurostimulator with concomitant laser-assisted lead and intracardiac cardiac defibrillator extraction due to Staphylococcus aureus pocket infection. HeartRhythm Case Rep 2016; 2:208-210. [PMID: 28491671 PMCID: PMC5419734 DOI: 10.1016/j.hrcr.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Shrinivas Hebsur
- Division of Cardiac Electrophysiology, University of California-San Diego, La Jolla, California
| | - Travis Pollema
- Division of Cardiac Surgery, University of California-San Diego, La Jolla, California
| | | | - Victor Pretorius
- Division of Cardiac Surgery, University of California-San Diego, La Jolla, California
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