scholarly journals 689 Hybrid transvenous and surgical approach for the extraction of coronary sinus leads: a case series

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Ashraf Ahmed ◽  
Gianmarco Arabia ◽  
Luca Bontempi ◽  
Manuel Cerini ◽  
Francesca Salghetti ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Case Series ◽  
Proximal Part ◽  
The Other ◽  
Right Atrial ◽  
Lead Extraction ◽  
Cardiac Device ◽  
Surgical Extraction ◽  
Coronary Sinus Lead ◽  
Transvenous Approach

Abstract Aims The rates of cardiac device-related infection have increased substantially over the past years. Transvenous lead extraction is the standard therapy for such cases. In some patients, however, the procedure cannot be completed through the transvenous route alone. A hybrid surgical and transvenous approach may provide the solution in such cases. Methods and results We present three cases who underwent hybird transvenous and surgical extraction for coronary sinus leads due to infection of CRT-D systems. One patient had an Attain Starfix lead implanted in the coronary sinus. The procedures were performed under local anaesthesia with continuous haemodynamic and transthoracic echocardiographic monitoring. We highlight the characteristics of the patients, the features of the devices, the technical difficulties, and the outcomes of the procedures. In all cases, the right atrial and right ventricular leads were extracted through the transvenous route. In one patient, they were extracted using regular stylets and manual traction, while in the other two patients, telescoping dilator sheaths (Cook), Tightrail hand-powered mechanical sheaths (Spectranetics), and/or Glidelight Excimer Laser sheaths (Spectranetics) were used. The coronary sinus lead could not be retrieved due to extensive fibrosis after utilizing locking stylets and mechanical dilator sheaths in all three cases, in addition to rotational mechanical sheaths and laser sheaths in one case, so the patients were referred to surgery. Two patients underwent left mini-thoracotomy and one patient underwent midline sternotomy to extract the remaining CS lead. The target vein was identified and ligated, then the fibrosis around the lead was dissected, this was followed by lead retrieval through the surgical incision. The patient who underwent sternotomy suffered from mediastinitis, which required reoperation and mediastinal lavage. There were no complications in the other two patients. All three patients were reimplanted with a new CRT-D device on the contralateral side after the resolution of infection. Conclusions A hybrid surgical and transvenous approach can be complementary in case the transvenous route alone fails to completely extract the coronary sinus lead. The transvenous approach can be used to free the proximal part of the lead, while the distal adhesions can be removed surgically, preferably though a limited thoracic incision.

scholarly journals Emergency sandwich patch repair via right ventricular incision for postinfarction ventricular septal defects: a case series

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Yusuke Shimahara ◽  
Satsuki Fukushima ◽  
Shin Yajima ◽  
Naoki Tadokoro ◽  
Takashi Kakuta ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Right Ventricular ◽  
Artery Bypass ◽  
Case Series ◽  
The Other ◽  
Patch Repair ◽  
Right Atrial ◽  
Residual Shunt ◽  
Low Cardiac Output Syndrome ◽  
St Segment Elevation

Abstract Background The surgical treatment for postinfarction ventricular septal defect (VSD) remains challenging, especially in emergency cases. Several authors have reported the efficacy of a sandwich patch VSD repair via a right ventricular (RV) incision. However, this procedure remains uncommon, and its efficacy is still unknown, especially when performed under an emergency. Case summary We were able to perform sandwich patch VSD repair via an RV incision on seven consecutive patients with VSD following an ST-segment elevation myocardial infarction (STEMI) from March 2017 to December 2019. Bovine pericardial patches were used for sandwich patches. Two patients developed inferior STEMI, and the other patients developed anterior STEMI. Six patients received intra-aortic balloon pump prior to surgery, and the other received extracorporeal membrane oxygenation with Impella. The interval between the diagnosis of VSD and surgery was within 1 day in all patients except one (5 days). All seven patients underwent VSD repair in the emergency status. Four patients underwent concomitant coronary artery bypass grafting. The hospital mortality rate was 14.3% (1/7). Early postoperative transthoracic echocardiography revealed that only one patient developed more than trace residual shunt. The postoperative right atrial pressure was not significantly elevated at ≤12 mmHg in all patients. No patient developed early postoperative prolonged low cardiac output syndrome. Discussion In patients with postinfarction VSD, a sandwich patch VSD repair via an RV incision is a promising procedure with a low incidence of residual shunt development and hospital mortality, even in emergency cases.

Coronary Sinus Lead Extraction

2017 ◽  
Vol 13 (1) ◽  
pp. 105-115 ◽  
Author(s):  
Edmond M. Cronin ◽  
Bruce L. Wilkoff
Keyword(s):  
Coronary Sinus ◽  
Lead Extraction ◽  
Coronary Sinus Lead

Large, Single-Center Experience in Transvenous Coronary Sinus Lead Extraction: Procedural Outcomes and Predictors for Mechanical Dilatation

2011 ◽  
Vol 35 (2) ◽  
pp. 215-222 ◽  
Author(s):  
ANDREA DI CORI ◽  
MARIA GRAZIA BONGIORNI ◽  
GIULIO ZUCCHELLI ◽  
LUCA SEGRETI ◽  
STEFANO VIANI ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Lead Extraction ◽  
Single Center ◽  
Single Center Experience ◽  
Coronary Sinus Lead ◽  
Procedural Outcomes

scholarly journals Usefulness of mechanical transvenous dilation and location of areas of adherence in patients undergoing coronary sinus lead extraction

EP Europace ◽  
2007 ◽  
Vol 9 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Maria Grazia Bongiorni ◽  
Giulio Zucchelli ◽  
Ezio Soldati ◽  
Giuseppe Arena ◽  
Gabriele Giannola ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Lead Extraction ◽  
Coronary Sinus Lead

Primum atrial septal laceration following coronary sinus lead extraction

2019 ◽  
Vol 21 (6) ◽  
pp. 701-701
Author(s):  
Mariateresa Librera ◽  
Guido Carlomagno ◽  
Claudia Calvanese ◽  
Tommaso Lonobile ◽  
Giuseppe De Martino
Keyword(s):  
Coronary Sinus ◽  
Lead Extraction ◽  
Coronary Sinus Lead

Abstract 11914: Coronary Sinus Lead Extraction_Laser Required

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Erin A Fender ◽  
Charles A Henrikson
Keyword(s):  
Coronary Sinus ◽  
Dwell Time ◽  
Lead Extraction ◽  
Success Rates ◽  
Assisted Extraction ◽  
Endovascular Approach ◽  
Coronary Sinus Lead ◽  
Average Lead ◽  
Open Surgical Approach ◽  
Manual Traction

Introduction: Studies of coronary sinus (CS) lead extraction have reported high success rates with manual traction, but largely included leads with dwell times less than 3 years. Our aim was to evaluate CS lead extractions of more chronic leads and establish if dwell time was correlated to complexity of extraction. Methods: This is a single center, retrospective review of 96 consecutive lead extraction procedures. A total of 14 CS leads were identified. Results: Of the 14 CS lead extractions, 13 were successful from an endovascular approach. Indications included 8 cases of endocarditis, 4 pocket infections, 1 dislodged lead and 1 malfunctioning lead. Six extractions were performed with manual traction, dwell time of these leads ranged from 5 months to 28 months, with an average implant time of 10.8 months. Eight extractions required use of a laser sheath (LS) to free the lead from adhesions. In no case was the LS used within the CS. The dwell time of these leads ranged from 45 months to 114 months, with an average lead age of 83.4 months. One LS case also required use of a rotating mechanical sheath. In one LS assisted extraction, the lead fragmented within the CS and could not be recovered endovascularly despite the use of multiple snares. This lead fragment was removed via an open surgical approach. Conclusion: CS leads require the use of advanced extraction tools in the majority of patients. All leads placed in the preceding 28 months were removed with simple manual traction, however all leads that were in place for more than 3 years required use of a LS. In contrast to prior reports, we found that coronary sinus leads posed the same procedural challenges as other cardiac leads and typically require advanced extraction tools.

scholarly journals Active fixation coronary sinus lead extraction – A safe procedure

2016 ◽  
Vol 35 (9) ◽  
pp. 505-506
Author(s):  
Tatiana Guimarães ◽  
Gustavo Lima da Silva ◽  
Ana Bernardes ◽  
João de Sousa ◽  
Pedro Marques
Keyword(s):  
Coronary Sinus ◽  
Lead Extraction ◽  
Safe Procedure ◽  
Active Fixation ◽  
Coronary Sinus Lead

scholarly journals Coronary sinus atrial septal defects in adults over the past 20 years at new Tokyo hospital: case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Haruhiko Sugimori ◽  
Tatsuya Nakao ◽  
Yuki Ikegaya ◽  
Daisuke Iwahashi ◽  
Shoichi Tsuda ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Surgical Repair ◽  
Wide Spectrum ◽  
Superior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Right Atrial ◽  
Valvular Regurgitation ◽  
Type Iv ◽  
The Right

Abstract Background An isolated coronary sinus (CS) atrial septal defect (ASD) is defined as a CS unroofed in the terminal portion without a persistent left superior vena cava or other anomalies. This defect is rare and part of the wide spectrum of unroofed CS syndrome (URCS). Recently, several reports have described this finding. The database of New Tokyo Hospital was searched to determine the incidence of this defect. Additionally, to raise awareness of this condition, the findings from five patients with CS ASD who underwent surgical repair at New Tokyo Hospital are discussed. Case presentation The patients were three women and two men with an age range of 63–77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with different combinations and degrees of mitral, tricuspid, and aortic valve involvement. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. Conclusions CS ASD (Kirklin and Barratt–Boyes type IV URCS) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries at New Tokyo Hospital from 1999 to 2019. At New Tokyo Hospital, cardiac surgery is performed mainly for patients with acquired cardiac disease, and CS ASD is rare. Early diagnosis is important, as well as early surgical repair in symptomatic patients, especially those with blood access shunts, which may overload the heart. The case of a poor prognosis in this series is noteworthy, as similar cases have not been reported previously.

scholarly journals First experience in quadripolar active fixation coronary sinus lead extraction: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Elhosseyn Guella ◽  
Michael Brack ◽  
Khalid Abozguia ◽  
Christopher John Cassidy
Keyword(s):  
Coronary Sinus ◽  
Atrioventricular Node ◽  
Right Atrial ◽  
Cardiac Resynchronization ◽  
Lead Extraction ◽  
Active Fixation ◽  
First Case ◽  
Potential Difficulty ◽  
History Of ◽  
The Right

Abstract Background The Attain Stability Quadripolar 4798 lead is a relatively new quadripolar active fixation coronary sinus (CS) lead. No cases of extraction of a chronically implanted 4798 lead have been published to date. Case summary A 52-year-old man with a history of previous cardiac resynchronization therapy pacemaker (CRT-P) insertion and atrioventricular node ablation presented to our institution with a pocket infection 69 weeks after implantation. Directed intravenous antibiotic therapy was commenced and an extraction was performed the following day. Extraction of the right atrial and right ventricular leads was simple and achieved with gentle manual traction. Extraction of the CS lead was more difficult. Significant traction was required due to the formation of adhesions inside the CS but extraction of the lead was eventually successful without complication. Specialized extraction equipment was not required. A new contralateral CRT-P device was implanted, and the patient was discharged home. He remains well at 3 months of follow-up. Discussion We present the first case of extraction of a chronically implanted active fixation Attain Stability Quadripolar lead. Our experience demonstrates that this has been performed successfully without specialist tools and with preservation of the CS branch. Significant adhesion was noted at the site of active fixation, however. Potential difficulty with this lead’s extraction should therefore be considered when contemplating its use.

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