The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction

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

EP Europace ◽

10.1093/europace/euaa162.283 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

D Nowosielecka ◽

L Tulecki ◽

K Tomkow ◽

A Kleinrok ◽

W Jachec ◽

...

Keyword(s):

Risk Factors ◽

Lead Extraction ◽

Arterial Line ◽

First Line ◽

Technical Problems ◽

Major Complications ◽

Duration Time ◽

Large Populations ◽

Cardiac Surgeon ◽

Procedural Success

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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Cardiac surgeon and electrophysiologist shoulder-to-shoulder approach: Hybrid room, a kingdom for two. A zero mortality transvenous lead extraction single center experience

International Journal of Cardiology ◽

10.1016/j.ijcard.2018.12.074 ◽

2019 ◽

Vol 279 ◽

pp. 35-39 ◽

Cited By ~ 1

Author(s):

Maurizio Roberto ◽

Rita Sicuso ◽

Sabrina Manganiello ◽

Valentina Catto ◽

Luca Salvi ◽

...

Keyword(s):

Lead Extraction ◽

Single Center ◽

Single Center Experience ◽

Cardiac Surgeon

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655 The valuable interaction among cardiac surgeon and electrophysiologist for transvenous rotational mechanical lead extraction

European Heart Journal Supplements ◽

10.1093/eurheartj/suab127.019 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Federico Migliore ◽

Vincenzo Tarzia ◽

Pietro Bernardo Dall’Aglio ◽

Pasquale Valerio Falzone ◽

Sabino Iliceto ◽

...

Keyword(s):

Success Rate ◽

Clinical Success ◽

Hybrid Approach ◽

Vena Cava ◽

Clinical Success Rate ◽

Left Ventricular ◽

Lead Extraction ◽

Lead Removal ◽

Team Approach ◽

Cardiac Surgeon

Abstract Aims Recent studies have shown that evolution RL bidirectional rotational mechanical sheath (Cook Medical, USA) is an effective and safe technique for transvenous lead extraction (TLE). We reported our experience with the bidirectional rotational mechanical tools using a multidisciplinary approach highlighting the value of a joint cardiac surgeon and electrophysiologist collaboration. Methods and results The study population comprised 84 patients (77% male; mean age 65 ± 18 years) undergoing TLE. After multidisciplinary evaluation, a combined procedure was considered. The main indication for TLE was infection in 54 cases (64%).Overall, 152 leads were extracted with a mean implant duration of 94 ± 63 months (range: 6–421). Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 91.6% (77/84), 97.6% (82/84), and 98.6% (150/152), respectively. Eighteen combined procedures were performed in 12 patients (14%), such as ‘hybrid approach’ (n = 2) or TLE concomitant to: (i) transcatheter aspiration procedure for large vegetation (n = 8); (ii) left ventricular assistance device implantation as bridge to cardiac transplantation (n = 1); (iii) permanent pacing with epicardial leads (n = 6); and (iv) tricuspid valve replacement (n = 1).One major complication (1.2%) and 11 (13%) minor complications were encountered. No injury to the superior vena cava occurred and no procedure-related deaths were reported. During a mean time follow-up of 21 ± 18 months, 17 patients (20%) died. They were more often diabetics (P = 0.02), and they underwent TLE more often for infection (P = 0.004). Conclusions Our results support the finding that excellent outcomes can be achieved in performing TLE of chronically implanted leads by using the evolution RL bidirectional rotational mechanical sheath and a multidisciplinary team approach involving both electrophysiologist and cardiac surgeon as first line operators.

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Lead Extraction – Future Treatment for an Old Problem

European Journal of Arrhythmia & Electrophysiology ◽

10.17925/ejae.2017.03.01.17 ◽

2017 ◽

Vol 03 (01) ◽

pp. 17

Author(s):

Luca Bontempi ◽

Francesca Vassanelli ◽

Antonio Curnis ◽

◽

...

Keyword(s):

High Risk ◽

Multidisciplinary Team ◽

Implantation Rate ◽

Lead Extraction ◽

Future Treatment ◽

Cardiac Devices ◽

Operative Strategies ◽

Cardiac Surgeon ◽

Laser Techniques ◽

Implantable Cardiac Defibrillators

The implantation rate of electronic cardiac devices, such as pacemakers and implantable cardiac defibrillators, has grown substancially over recent years. As a consequence, we are facing a rising number of related complications, such as systemic and/or local infections and malfunctions. It is generally accepted that transvenous lead extraction (TLE) is actually the better strategy to manage the majority of such complications, although the procedure is not exempt from minor and major risks. Despite the advent of laser techniques, surgery may still be required in both elective and emergency cases. Hybrid operative strategies (TLE combined with minithoracotomy and thoracoscopy) have been developed for procedures considered to confer an high risk. The strict collaboration between electrophysiologist and cardiac surgeon, and the setting up of a multidisciplinary team, are crucial points at each step of a planned TLE procedure.

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