The role of cardiac surgery in transvenous lead extraction. A high-volume center experience with 3207 procedures

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.

Knowledge and Awareness of Postextraction Complications among Dental Seniors and Interns in Riyadh Province

Background

Postextraction complications are multifactorial. Taking proper medical and dental history, thorough planning, and a skillful dentist can help the prediction and reduction of these complications.

Objective

This study aims to assess and compare the knowledge of senior students and interns regarding postextraction complications in government and private colleges in Riyadh Province.

Materials and Methods

A random sampling technique was used to select a minimum of 250 participants for this study. A self-designed, close-ended questionnaire was disseminated through an online platform in a manner. Sixth-year (senior) dental students and interns were included in the study. Data were coded and entered into spreadsheet software and analyzed using Chi-square tests.

Results

More than half were dental interns (54.04%), and the rest were senior students (45.96%). Male participants comprised 52.57% of the total participants, whereas females were 47.43%. Most participants were from government colleges (53.31%), whereas 46.69% belonged to private colleges. Male interns from government colleges demonstrated the best knowledge among all the participants. In private colleges, females demonstrated better knowledge than males in both the senior and intern groups, and the difference was statistically significant. The difference in knowledge between participants from government and private colleges was found to be statistically significant (P = 0.001). Government colleges were found to demonstrate more complications than private colleges, and the difference was statistically significant (P = 0.003).

Conclusion

Male interns from government colleges had the best knowledge about the postextraction complications among the candidates.

Influence of nail biting and finger sucking habits on the oral carriage of Enterobacteriaceae

BACKGROUND

Oral habits like thumb sucking and nail biting are pernicious habits that act as an adaptive function in obtaining pleasure and subduing anxiety. These habits may also act as carriers of numerous microorganisms into the oral cavity, of which, Enterobacteriaceae members are transient pathogens, which might result in debilitating systemic conditions.

AIM

To study the oral carriage of Enterobacteriaceae in children having habit of nail biting and thumb sucking. And to study the association of the organism with the individual's respective plaque indices.

SUBJECTS AND METHODS

Totally, 40 chronic nail biters, 40 chronic thumb suckers, and 20 controls (no habit) (8-15 years old) were enrolled in the study. Appropriate history and their plaque indices recorded. Sterile containers were used to collect the salivary samples and later cultured on Agar plates. Biochemical tests categorized the organisms into subspecies.

STATISTICAL ANALYSIS USED

ANNOVA, Student's t-test.

RESULTS

Presence of a nail biting habit indicated a higher plaque index, which in turn showed a higher carriage of Enterobacteria spps, predominantly Escherichia coli.

CONCLUSIONS

Oral surgical intervention in individuals with pernicious oral habits need to be counseled and educated on the possible complications, which might otherwise provide an environment that disseminates these microorganisms resulting in a broad range of local and systemic infections.