Introduction:
There is a risk of serious complications with high-risk lead extraction (LE) that may increase mortality. Current guidelines do not provide definitive guidance on collaborative involvement of cardiac surgery as compared to other procedures such as TAVR procedures. We report a single center experience of the benefits of a collaborative approach between cardiac surgery and cardiac electrophysiology (EP).
Hypothesis:
MDHT will improve outcomes in LE
Methods:
High risk lead extractions had dwell times of at least 4 years for pacemaker leads and 2 years for ICD leads. A multidisciplinary heart team (MDHT) was created based on the TAVR model that includes a combined lead management clinic and a monthly multidisciplinary conference. Prior to MDHT creation, high risk lead extractions were performed either in the hybrid operating room (OR) and cardiology procedure lab with a surgeon on call as needed. After the MDHT creation all cases were performed in the hybrid operating room by a cardiac surgeon, cardiac anesthesiologist and EP together with an interventional radiologist readily available.
Results:
Prior to MDHT, 169 patients underwent 344 leads extractions. There were six major procedural complications (3.6%) that included 2 procedural deaths (1.2%) during that period (SVC tear, Tricuspid valve avulsion). Following the creation of MDHT, there have been 47 cases performed with 85 leads extracted. There have been two complications requiring surgical repair (one SVC laceration, one RV laceration), which were surgically repaired. With the creation of a MDHT, the rate of major complications was unchanged (Pre vs. Post MDHT 3.6% vs. 4.3%) but there was a lower mortality rate (Pre vs. Post MDHT 1.2% vs. 0%).
Conclusions:
High risk lead extraction had a fixed complication rate at our institution however a MDHT decreased mortality. A structured multidisciplinary approach, involving EP and cardiac surgery, decreased mortality in a medium sized lead extraction center and should be considered at all centers.
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