scholarly journals Lead Extraction – Future Treatment for an Old Problem

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.

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

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

scholarly journals A Historical Perspective of Cardiac Implantable Electronic Device Infection: How a Menace Can Drive Technological and Clinical Improvement

Hearts ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 202-212
Author(s):  
Giulia Massaro ◽  
Igor Diemberger ◽  
Matteo Ziacchi ◽  
Andrea Angeletti ◽  
Giovanni Statuto ◽  
...  
Keyword(s):  
Electronic Device ◽  
Positive Impact ◽  
Delayed Diagnosis ◽  
Implantation Rate ◽  
Major Complication ◽  
Lead Extraction ◽  
Cardiac Implantable Electronic Devices ◽  
Device Infection ◽  
New Perspective ◽  
Poor Outcomes

In recent decades there has been a relevant increase in the implantation rate of cardiac implantable electronic devices (CIEDs), albeit with relevant geographical inhomogeneities. Despite the positive impact on clinical outcomes, the possibility of major complications is not negligible, particularly with respect to CIED infections. CIED infections significantly affect morbidity and mortality, especially in instances of delayed diagnosis and appropriate treatment. In the present review, we will start to depict the factors underlying the development of CIED infection as well as the difficulties related to its diagnosis and treatment. We will explain the reasons underlying the need to focus on prophylaxis rather than treatment, in view of the poor outcomes despite improvements in lead extraction procedures. This will lead to the consideration of management of this complication in a hub-spoke manner, and to our analysis of the several technological and procedural improvements developed to minimize this complication. These include prolongation of CIED longevity, the development of leadless devices, and integrated prophylactic approaches. We will conclude with a discussion regarding new devices and strategies under development. This complete excursus will provide the reader with a new perspective on how a major complication can drive technological improvements.

Abstract 17362: A Multidisciplinary Heart Team Approach to High Risk Transvenous Pacemaker and Defibrillator Lead Extraction Improves Mortality

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Ryan G Aleong ◽  
Matthew Zipse ◽  
Christine Tompkins ◽  
Tamas Seres ◽  
David Fullerton ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Operating Room ◽  
Cardiac Electrophysiology ◽  
Lead Extraction ◽  
Team Approach ◽  
Heart Team ◽  
Hybrid Operating Room ◽  
Icd Leads ◽  
The Creation

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.

scholarly journals Comparison of Orthognathic Surgery Outcomes Between Patients With and Without Underlying High-Risk Conditions: A Multidisciplinary Team-Based Approach and Practical Guidelines

2019 ◽  
Vol 8 (11) ◽  
pp. 1760 ◽  
Author(s):  
Chou ◽  
Denadai ◽  
Chen ◽  
Pai ◽  
Hsu ◽  
...  
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Multidisciplinary Team ◽  
Orthognathic Surgery ◽  
Wide Spectrum ◽  
Well Being ◽  
Intraoperative Blood Loss ◽  
Healthy Individuals ◽  
Patient Reported ◽  
Comorbidity Scores

Orthognathic surgery (OGS) has been successfully adopted for managing a wide spectrum of skeletofacial deformities, but patients with underlying conditions have not been treated using OGS because of the relatively high risk of surgical anesthetic procedure-related complications. This study compared the OGS outcomes of patients with and without underlying high-risk conditions, which were managed using a comprehensive, multidisciplinary team-based OGS approach with condition-specific practical perioperative care guidelines. Data of surgical anesthetic outcomes (intraoperative blood loss, operative duration, need for prolonged intubation, reintubation, admission to an intensive care unit, length of hospital stay, and complications), facial esthetic outcomes (professional panel assessment), and patient-reported outcomes (FACE-Q social function, psychological well-being, and satisfaction with decision scales) of consecutive patients with underlying high-risk conditions (n = 30) treated between 2004 and 2017 were retrospectively collected. Patients without these underlying conditions (n = 30) treated during the same period were randomly selected for comparison. FACE-Q reports of 50 ethnicity-, sex-, and age-matched healthy individuals were obtained. The OGS-treated patients with and without underlying high-risk conditions differed significantly in their American Society of Anesthesiologists Physical Status (ASA-PS) classification (p < 0.05), Charlson comorbidity scores, and Elixhauser comorbidity scores. The two groups presented similar outcomes (all p > 0.05) for all assessed outcome parameters, except for intraoperative blood loss (p < 0.001; 974.3 ± 592.7 mL vs. 657.6 ± 355.0 mL). Comparisons with healthy individuals revealed no significant differences (p > 0.05). The patients with underlying high-risk conditions treated using a multidisciplinary team-based OGS approach and the patients without the conditions had similar OGS-related outcomes.

scholarly journals P1769The bridge occlusion balloon as a safety net in high-risk transvenous lead extraction procedures: a novel approach

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii388-iii388
Author(s):  
S. Hakmi ◽  
S. Pecha ◽  
J. Vogler ◽  
N. Gosau ◽  
S. Willems ◽  
...  
Keyword(s):  
High Risk ◽  
Safety Net ◽  
Lead Extraction ◽  
Occlusion Balloon ◽  
Extraction Procedures ◽  
Novel Approach

scholarly journals Impact of Multidisciplinary Team on Duodenoscope Reprocessing to Minimize Infections with High-Risk Organisms

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S193-S193
Author(s):  
Evan Mosier ◽  
Preciosa Marasigan ◽  
Stephanie Hall ◽  
Neha Nanda
Keyword(s):  
High Risk ◽  
Multidisciplinary Team

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

2021 ◽  
Author(s):  
Federico Migliore ◽  
Vincenzo Tarzia ◽  
Pietro Bernardo Dall'Aglio ◽  
Pasquale Valerio Falzone ◽  
Manuel De Lazzari ◽  
...  
Keyword(s):  
Lead Extraction ◽  
Cardiac Surgeon

Abstract 17130: Systemic Infection From Non-Pocket Source is Associated With Worse Outcomes Compared With Pocket Source

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
MUHAMMAD ZUBAIR KHAN ◽  
Kay Khine ◽  
Heath Saltzman ◽  
Steven P Kutalek ◽  
Ashwani Gupta
Keyword(s):  
Systemic Infection ◽  
Lead Extraction ◽  
P Value ◽  
Coagulase Negative Staphylococcus ◽  
Cardiac Devices ◽  
Kaplan Meier ◽  
Source Data ◽  
Long Term Mortality

Introduction: Systemic infection can occur in patients with cardiac devices due to spread from pocket infection or a non-pocket source. Data comparing outcomes of systemic infection from pocket vs. non-pocket source are lacking Hypothesis: We hypothesized that systemic infection from non-pocket source is associated with worse outcomes compared with pocket source. Methods: We collected data for all patients with systemic infection, who underwent transvenous lead extraction (TLE) between April 2004 and June 2015. Patients were divided into 2 groups- systemic infection from pocket source and non-pocket source. Results: Out of total 700 TLE procedures for infectious indication, 407 patients (58.1%) had evidence of systemic infection. Out of these, 167 (41%) had systemic infection from pocket source and 240 (59%) had systemic infection from non-pocket sources. Patients with pocket source were older (69.7± 13.4 vs. 66.3± 13.5 years, p value 0.011), less likely to be on dialysis (8.4% vs. 23.8%), and more likely to have CRT system (39.5% vs. 23.8%). Pocket source group had higher incidence of coagulase negative staphylococcus infection (32.3% vs. 19.6%) and presence of abandoned leads (32.3% vs. 10.8%).Patients with non-pocket source were more likely to have endocarditis (81.7% vs. 55.1%). There was no difference in TLE procedure outcomes, complications during hospital stay, and 30-day mortality (10.3% vs. 13.7%, p value 0.330). However, 1-year mortality was significantly higher in patients with non-pocket source (41% vs. 28.1%, p value 0.019). Kaplan-Meier survival curves showed worse survival in non-pocket source group up to 6 years of follow up. Conclusions: In conclusion, there is no difference in procedural or short-term outcomes between patients with systemic infection from pocket vs. non-pocket source after TLE. However, patients with systemic infection from non-pocket source are more likely to have endocarditis and have worse long-term mortality.

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