1256Monitoring of TLE procedure using TEE does it influences for procedure efficacy ? The comparison of two large populations (1058 and 2068 patients)

Abstract Background To improve safety of lead extraction monitoring by using continuous TEE was proposed and introduced recently (after the introduction of cardiac surgeon presence, optimal venue such as hybrid room, arterial line etc). However, until now it is not proved that it works in practice. Objective The goal of this study was to compare TLE effectiveness and safety between two large group with TLE performed with and without TEE monitoring. Methods During last 15 years 3126 TLE were performed; 5183 leads (1-6 leads, aver 1,65, with mean implant duration time 95,7 mth) were extracted using - as first line - non-powered mechanical tools. Results In spite of the fact that the group which was monitored with TEE was sicker (Carlson’s index, lower EF), had more TLE risk factors (implant duration) and TLE procedure was much more difficult (more technical problems) – the TLE effectiveness was better (more radiological, clinical and procedural success, less partial radiological success) and major complications was even slightly less frequent. Unexpected differences in mid-term mortality can be explained by different rate of infective indications or lead remnant influence. Conclusions Results seem to indicate favourable effects of utility TEE for TLE procedure monitoring. Abstract Figure.

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Analysis of Risk Factors for Major Complications of 1500 Transvenous Lead Extraction Procedures with Especial Attention to Tricuspid Valve Damage

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179100 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9100

Author(s):

Łukasz Tułecki ◽

Anna Polewczyk ◽

Wojciech Jacheć ◽

Dorota Nowosielecka ◽

Konrad Tomków ◽

...

Keyword(s):

Risk Factors ◽

Tricuspid Valve ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Lead Extraction ◽

Safe Procedure ◽

Term Survival ◽

Technical Problems ◽

Extraction Procedures ◽

Major Complications

Background: Transvenous lead extraction (TLE) is a relatively safe procedure, but it may cause severe complications such as cardiac/vascular wall tear (CVWT) and tricuspid valve damage (TVD). Methods: The risk factors for CVWT and TVD were examined based on an analysis of data of 1500 extraction procedures performed in two high-volume centers. Results: The total number of major complications was 33 (2.2%) and included 22 (1.5%) CVWT and 12 (0.8%) TVD (with one case of combined complication). Patients with hemorrhagic complications were younger, more often women, less often presenting low left ventricular ejection fraction (LVEF) and those who received their first cardiac implantable electronic device (CIED) earlier than the control group. A typical patient with CVWT was a pacemaker carrier, having more leads (including abandoned leads and excessive loops) with long implant duration and a history of multiple CIED-related procedures. The risk factors for TVD were similar to those for CVWT, but the patients were older and received their CIED about nine years earlier. Any form of tissue scar and technical problems were much more common in the two groups of patients with major complications. Conclusions: The risk factors for CVWT and TVD are similar, and the most important ones are related to long lead dwell time and its consequences for the heart (various forms of fibrotic scarring). The occurrence of procedural complications does not affect long-term survival in patients undergoing lead extraction.

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Transvenous lead extraction procedures in women based on ESC-EHRA EORP European Lead Extraction ConTRolled ELECTRa registry: is female sex a predictor of complications?

EP Europace ◽

10.1093/europace/euz277 ◽

2019 ◽

Author(s):

Anna Polewczyk ◽

Christopher A Rinaldi ◽

Manav Sohal ◽

Pier-Giorgio Golzio ◽

Simon Claridge ◽

...

Keyword(s):

Risk Factors ◽

Clinical Success ◽

Signs And Symptoms ◽

Venous Occlusion ◽

Lead Extraction ◽

Blood Cell Count ◽

Female Sex ◽

Major Complications ◽

Lead Management ◽

Post Hoc

Abstract Aims Female sex is considered an independent risk factor of transvenous leads extraction (TLE) procedure. The aim of the study was to evaluate the effectiveness of TLE in women compared with men. Methods and results A post hoc analysis of risk factors and effectiveness of TLE in women and men included in the ESC-EHRA EORP ELECTRa registry was conducted. The rate of major complications was 1.96% in women vs. 0.71% in men; P = 0.0025. The number of leads was higher in men (mean 1.89 vs. 1.71; P < 0.0001) with higher number of abandoned leads in women (46.04% vs. 34.82%; P < 0.0001). Risk factors of TLE differed between the sexes, of which the major were: signs and symptoms of venous occlusion [odds ratio (OR) 3.730, confidence interval (CI) 1.401–9.934; P = 0.0084], cumulative leads dwell time (OR 1.044, CI 1.024–1.065; P < 0.001), number of generator replacements (OR 1.029, CI 1.005–1.054; P = 0.0184) in females and the number of leads (OR 6.053, CI 2.422–15.129; P = 0.0001), use of powered sheaths (OR 2.742, CI 1.404–5.355; P = 0.0031), and white blood cell count (OR 1.138, CI 1.069–1.212; P < 0.001) in males. Individual radiological and clinical success of TLE was 96.29% and 98.14% in women compared with 98.03% and 99.21% in men (P = 0.0046 and 0.0098). Conclusion The efficacy of TLE was lower in females than males, with a higher rate of periprocedural major complications. The reasons for this difference are probably related to disparities in risk factors in women, including more pronounced leads adherence to the walls of the veins and myocardium. Lead management may be key to the effectiveness of TLE in females.

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P3137Transvenous lead extraction in patients under 30 years of age results from two high volume European centers

European Heart Journal ◽

10.1093/eurheartj/ehz745.0212 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

W Jachec ◽

A Polewczyk ◽

L Segreti ◽

M G Bongiorni ◽

A Kutarski

Keyword(s):

Young People ◽

Clinical Success ◽

Young Patients ◽

High Volume ◽

Young Age ◽

Lead Extraction ◽

Specific Group ◽

Technical Problems ◽

Major Complications ◽

Simple Systems

Abstract Background Young patients are a specific group undergoing transvenous leads extraction (TLE) procedures due to different anatomy, intensive connecting tissue scar and earlier calcification. Aim Evaluation of results of TLE in young patients compared to adults above 30 years old Examined Groups and Methods: 3810 patients (mean age at the time of procedure; 65,21±15,84 years old, 1301 female) who underwent TLE procedures in two high volume experienced European centers (Poland and Italy). We compared clinical and procedural factors in two groups of patients: under the age of 30 (n=172) and between 30 and 80 (n=3054) with exclusion 584 patients above 80 years old. Results Results are presented in Table 1. A: p<0,05, AA; p<0,01, AAA; p<0,001, NS Conclusion Infective indications are less frequent in very young people. In spite of presence of simple systems in this patients the effectiveness of TLE remains lower- with documented lower rate of procedural and clinical success Young age does not influence on the appearance of major complications and procedure related death, however, the frequency of technical problems is increased due to necessity of extraction older, strongly ingrown, calcified leads. TLE in young patients is usually a big challenge and should be performed by the most experienced operators in high volume centers.

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Transvenous lead extraction outcomes using a novel hand-powered bidirectional rotational sheath as a first-line extraction tool in a low-volume centre

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa286 ◽

2020 ◽

Author(s):

Jus Ksela ◽

Jan Prevolnik ◽

Mark Racman

Keyword(s):

Clinical Success ◽

High Volume ◽

Lead Extraction ◽

Success Rates ◽

First Line ◽

Line Extraction ◽

Cardiovascular Implantable Electronic Devices ◽

Skilled Operator ◽

Low Volume ◽

Procedural Success

Abstract OBJECTIVES Extraction of cardiovascular implantable electronic devices in low-volume medical centres with limited clinical experience and an evolving lead extraction programme may be challenging. We aimed to evaluate the safety and efficacy of stepwise transvenous lead extraction (TLE) using a novel type of hand-powered rotational sheath as a first-line tool for extraction of chronically implanted devices in a single, low-volume centre. METHODS Sixty-seven consecutive patients undergoing a TLE procedure using the novel Evolution® RL rotational sheath as the first-line extraction tool between 2015 and 2019 at our institution were enrolled in the study. Their short-term and 30-day outcomes were observed. RESULTS Sixty-nine devices and 131 leads were explanted. Procedural and clinical success rates were 92.4% and 98.5%, respectively. Two procedures were classified as failures due to lead remnants >4 cm remaining in patients’ vascular systems. One major (1.5%) and 3 minor (4.4%) adverse events and no deaths were observed. CONCLUSIONS TLE procedures, performed in a stepwise manner, using the Evolution RL sheath as a first-line extraction device and conducted by an experienced, surgically well-trained operator, offer excellent results with clinical and procedural success rates comparable to those, achieved in dedicated, high-volume institutions. Opting for optimal lead extraction approach in low-volume centres or institutions with evolving TLE programmes, a stepwise extraction strategy using the Evolution RL sheath by skilled operator may provide the optimal scheme with an excellent ratio between clinical and/or procedural success and complications.

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P1504Monitoring of TLE procedure using TEE practical utility Experience from 927 procedures

EP Europace ◽

10.1093/europace/euaa162.282 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

D Nowosielecka ◽

L Tulecki ◽

K Tomkow ◽

A Kleinrok ◽

W Jachec ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Tamponade ◽

Clinical Success ◽

Respiratory Monitoring ◽

Lead Extraction ◽

First Line ◽

Significant Drop ◽

Practical Utility ◽

After Effects ◽

Major Complications

Abstract Background Monitoring of the process of transvenous lead extraction using continuous TEE was delivered for the purpose of earlier recognition of cardiac or venuos wall tear (behind hemodynamic and respiratory monitoring etc). But our experience indicates that it may be providing much more very important information for operator about present occurrences invisible for fluoroscopy monitoring and to warm about threatening disaster. Objective The goal of this study was to describe frequency of menaces visible in TEE before after effects will reveal. Methods During last 4,5 years 1019 TLE were performed but due to different reasons complete TEE monitoring was performed in 910 patients; 1705 leads (1-4 leads, aver 1,66, with mean implant duration 100,7 mth) were extracted using as first line non-powered mechanical tools. There were 20 major complications (2,0%) but no procedure related death. We obtained 98,7% procedural and 97,9% clinical success. Results are presented in the table. Conclusions TEE cautioned about dangerous poling or torsion of the heart structures and permitted immediate explanation of the reasons of drop of blood pressure, brought information about arising cardiac tamponade, about rapid blood clothing in epicardial space and the onset of cave-in RV wall before significant drop of blood pressure. Uncomplicated course after rescue sternotomy seems be result of timeous it execution. Abstract Figure.

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The role of cardiac surgery in transvenous lead extraction (TLE) – experience from high volume center and 3207 procedures

European Heart Journal ◽

10.1093/ehjci/ehaa946.0836 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Tulecki ◽

M Czajkowski ◽

S Targonska ◽

K Tomkow ◽

D Nowosielecka ◽

...

Keyword(s):

Cardiac Surgery ◽

Tricuspid Valve ◽

Surgical Intervention ◽

Clinical Success ◽

Left Ventricular ◽

Lead Extraction ◽

Icd Leads ◽

Ventricular Lead ◽

Cardiac Surgeon

Abstract Background The guidelines suggest close co-operation between TLE operating team and cardiac surgery and its key role in the management of life-threatening complications remains unquestionable. But the role of cardiac surgeon seems to be much more extended. Purpose We have analysed the role of cardiac surgery in treatment of patients undergoing TLE procedures. Methods Using standard non-powered mechanical systems we have extracted ingrown PM/ICD leads from 3207 pts (38,7% female, average age 65,7-y) during the last 14 years. Non-infectious TLE indications were in 66,4% of patients. 46% had PM DDD system, 19% PM SSI, 22% ICD, 9% CRT, 4% other systems. In 12% of patients abandoned leads were found. 8% of patients had one lead, 54% - two, 15% - three and 4% - 4–6 leads in the heart. An average dwell time of all leads was 91,5 mth. The lead entry side was left in 96% of patients, right in 3% and both – 4%. Results Procedural success 96,1%, clinical success - 97,8%, procedure-related death 0,2%. Major complications appeared in 1,9% (cardiac tamponade 1,2%, haemothorax 0,2%, tricuspid valve damage 0,3%, stroke, pulmonary embolism <1%). Conclusions Rescue cardiac surgery (for severe haemorrhagic complications) is still the most frequent reason of surgical intervention (1,1%). The second area of co-operation includes supplementary cardiac surgery after (incomplete) TLE (0,8%). The third one is connected with reconstruction or replacement of tricuspid valve, which can be affected by ingrown lead or damaged during TLE procedure (0,5%). Implantation of the complete epicardial system during any surgical intervention (rescue or delayed) should be considered as a supplementation of the operation (0,65%). Some of patients after TLE need implantation of epicardial leads for permanent epicardial pacing (0,6%) and some only left ventricular lead to rebuild permanent cardiac resynchronisation (0,5%). The single experience of large TLE centre indicates the necessity of close co-operation with cardiac surgeon, whose role seems to be more comprehensive than a surgical stand-by itself. Table 1 Funding Acknowledgement Type of funding source: None

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Transvenous lead extraction: procedural outcomes and in-hospital mortality in octogenarian patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.0829 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Giannotti Santoro ◽

L Segreti ◽

G Zucchelli ◽

V Barletta ◽

A Di Cori ◽

...

Keyword(s):

Elderly Patients ◽

Hospital Mortality ◽

Electronic Device ◽

Clinical Success ◽

Similar Efficacy ◽

Lead Extraction ◽

Tertiary Referral Center ◽

Major Complications ◽

Group 2 ◽

Group 1

Abstract Background Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. Methods Patients who had undergone TLE in single tertiary referral center were divided in two groups (Group 1: ≥80 years; group 2:<80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation. Results Our analysis included 1316 patients (group 1: 202, group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities and more pacemakers, whereas the dwelling time of the oldest lead was similar, irrespectively of patient's age. In group 1 the radiological success rate for lead was higher (99.0% vs 95.9%; P<0.001) and the fluoroscopy time lower (13.0 vs 15.0 minutes; P=0.04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P=0.36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P=0.24). In the elderly group no in-hospital mortality occurred (0.0% vs 0.5%; P=0.42). Conclusions Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure and no procedural-related deaths. Funding Acknowledgement Type of funding source: None

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Prevention of Hypotension following Spinal Anaesthesia in Caesarean Section - then and now

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i4.6242 ◽

2012 ◽

Vol 8 (4) ◽

pp. 415-419

Author(s):

J K Mitra

Keyword(s):

Risk Factors ◽

Clinical Practice ◽

High Risk ◽

Caesarean Section ◽

Spinal Anaesthesia ◽

Limited Data ◽

First Line ◽

High Risk Patients ◽

Risk Patients ◽

Poor Efficacy

Hypotension during spinal anaesthesia for caesarean section remains a common scenario in our clinical practice. Certain risk factors play a role in altering the incidence of hypotension. Aortocaval compression counteraction does not help to prevent hypotension. Intravenous crystalloid prehydration has poor efficacy; thus, the focus has changed toward co-hydration and use of colloids. Phenylephrine is established as a first- line vasopressor, although there are limited data from high-risk patients. Ephedrine crosses the placenta more than phenylephrine and cause possible alterations in the foetal physiology.http://dx.doi.org/10.3126/kumj.v8i4.6242 Kathmandu Univ Med J 2010;8(4):415-19

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