scholarly journals Transvenous Lead Extraction SAFeTY Score for Risk Stratification and Proper Patient Selection for Removal Procedures Using Mechanical Tools

2020 ◽  
Vol 9 (2) ◽  
pp. 361 ◽  
Author(s):  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Maciej Polewczyk ◽  
Andrzej Tomasik ◽  
Andrzej Kutarski
Keyword(s):  
Young Patients ◽  
High Volume ◽  
Female Gender ◽  
Lead Extraction ◽  
Factors Associated ◽  
Major Complications ◽  
Proper Patient Selection ◽  
Related Risk ◽  
Risk Patients ◽  
Selection For

Background: To ensure the safety and efficacy of the increasing number of transvenous lead extractions (TLEs), it is necessary to adequately assess the procedure-related risk. Methods: We analyzed potential clinical and procedural risk factors associated with 2049 TLE procedures. The TLEs were performed between 2006 and 2016 using only simple tools for lead extraction. Logistic regression analysis was used to develop a risk prediction scoring system for TLEs. Results: Multivariate analysis showed that the sum of lead dwell times, anemia, female gender, the number of procedures preceding TLE, and removal of leads implanted in patients under the age of 30 had a significant influence on the occurrence of major complications during a TLE. This information served as a basis for developing a predictive SAFeTY TLE score, where: S = sum of lead dwell times, A = anemia, Fe = female, T = treatment (previous procedures), Y = young patients, and TLE = transvenous lead extraction. In order to facilitate the use of the SAFeTY TLE Score, a simple calculator was constructed. Conclusion: The SAFeTY TLE score is easy to calculate and predicts the potential occurrence of procedure-related major complications. High-risk patients (scoring more than 10 on the SAFeTY TLE scale) must be treated at high-volume centers with surgical backup.

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

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.

scholarly journals The Influence of Lead-Related Venous Obstruction on the Complexity and Outcomes of Transvenous Lead Extraction

2021 ◽  
Vol 18 (18) ◽  
pp. 9634
Author(s):  
Marek Czajkowski ◽  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Jarosław Kosior ◽  
Dorota Nowosielecka ◽  
...  
Keyword(s):  
Clinical Success ◽  
Technical Difficulty ◽  
High Volume ◽  
Lead Extraction ◽  
Short Term ◽  
Term Survival ◽  
Major Complications ◽  
Related Risk ◽  
Short Term Mortality

Background: Little is known about lead-related venous stenosis/occlusion (LRVSO), and the influence of LRVSO on the complexity and outcomes of transvenous lead extraction (TLE) is debated in the literature. Methods: We performed a retrospective analysis of venograms from 2909 patients who underwent TLE between 2008 and 2021 at a high-volume center. Results: Advanced LRVSO was more common in elderly men with a high Charlson comorbidity index. Procedure duration, extraction of superfluous leads, occurrence of any technical difficulty, lead-to-lead binding, fracture of the lead being extracted, need to use alternative approach and lasso catheters or metal sheaths were found to be associated with LRVSO. The presence of LRVSO had no impact on the number of major complications including TLE-related tricuspid valve damage. The achievement of complete procedural or clinical success did not depend on the presence of LRVSO. Long-term mortality, in contrast to periprocedural and short-term mortality, was significantly worse in the groups with LRSVO. Conclusions: LRVSO can be considered as an additional TLE-related risk factor. The effect of LRVSO on major complications including periprocedural mortality and on short-term mortality has not been established. However, LRVSO has been associated with poor long-term survival.

scholarly journals Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study

EP Europace ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1097-1102
Author(s):  
Anders Fyhn Elgaard ◽  
Jens Brock Johansen ◽  
Jens Cosedis Nielsen ◽  
Christian Gerdes ◽  
Sam Riahi ◽  
...  
Keyword(s):  
Clinical Success ◽  
Extraction Procedure ◽  
Clinical Success Rate ◽  
High Volume ◽  
Lead Extraction ◽  
Related Data ◽  
Major Complications ◽  
Long Term Follow Up

Abstract Aims  Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. Methods and results  All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. Conclusion  More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.

scholarly journals Prevalence, Reasons, and Predisposing Factors Associated with 30-day Hospital Readmissions in Poland

2019 ◽  
Vol 16 (13) ◽  
pp. 2339 ◽  
Author(s):  
Jacek Kryś ◽  
Błażej Łyszczarz ◽  
Zofia Wyszkowska ◽  
Kornelia Kędziora-Kornatowska
Keyword(s):  
Hospital Readmissions ◽  
High Volume ◽  
Female Gender ◽  
University Hospital ◽  
Treatment Practice ◽  
Factors Associated ◽  
Pediatric Transplantation ◽  
High Volume Hospital ◽  
Quality Issues ◽  
Initial Hospitalization

There is a growing interest in quality issues associated with hospital care, with readmissions (rehospitalizations) being one of the main areas of interest. Retrospective data from a 914-bed university hospital in Bydgoszcz, Poland, was used to identify 30-day readmissions in 2015. We developed a catalogue of reasons for rehospitalization and differentiated between planned and unplanned readmissions, as well as those related and unrelated to index (initial) hospitalization. Multilevel logistic regression was used to determine factors associated with readmission risk. A total of 12.5% of patients were readmitted within 30 days of being discharged. The highest readmission rates were identified in pediatric, transplantation, and urology patients. The highest share of readmissions was due to the specific nature of a disease and its routine treatment practice. Almost two-thirds of readmission cases were classified as unplanned and related to the index hospitalization. The following characteristics were associated with a higher risk of rehospitalization: female gender, residing >35 km from the hospital, longer than average and very short stays at index admission, higher comorbidity score, and admission to a high-volume hospital sector. Due to the importance of quality issues in health policy, the topic should be further pursued to identify evidence-based practices that would improve hospitals’ performance.

Surgical High-risk Patients With ASA ≥ 3 Undergoing Radical Cystectomy: Morbidity, Mortality, and Predictors for Major Complications in a High-volume Tertiary Center

2018 ◽  
Vol 16 (6) ◽  
pp. e1141-e1149 ◽  
Author(s):  
Gerald B. Schulz ◽  
Tobias Grimm ◽  
Alexander Buchner ◽  
Friedrich Jokisch ◽  
Alexander Kretschmer ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Cystectomy ◽  
High Volume ◽  
High Risk Patients ◽  
Major Complications ◽  
Tertiary Center ◽  
Risk Patients

scholarly journals Factors associated with quality of life in Italian children and adolescents with IBD

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Simona Gatti ◽  
Giada Del Baldo ◽  
Giulia Catassi ◽  
Andrea Faragalli ◽  
Marina Aloi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Internal Consistency ◽  
Young Patients ◽  
Female Gender ◽  
Negatively Associated ◽  
Factors Associated ◽  
Italian Children ◽  
The Impact ◽  
Active Disease

AbstractImproving the quality of life (QoL) is crucial in the management of pediatric inflammatory bowel disease (IBD). We aimed to (1) Validate the IMPACT-III questionnaire in Italian IBD children; (2) explore factors associated to QoL in pediatric IBD. Internal consistency, concurrent validity, discriminant validity and reproducibility of the Italian version of the IMPACT-III questionnaire was measured in IBD children/adolescents in 8 centers. Associations between patient and disease characteristics and the IMPACT-III domains were analyzed through quantile regression analysis. The IMPACT-III questionnaire, collected in 282 children with IBD (median age: 14.8 years; IQR 12.4–16.4) showed a median total score of 76 (IQR 67–83). Female gender, active disease and age were negatively associated with the total IMPACT-III score. Specifically, female gender was negatively associated with the Bowel/Systemic Symptoms, Emotional and Treatment domain scores, while disease activity was significantly associated with Bowel Symptoms and Treatment/Interventions reported QoL. The IMPACT- III showed good internal consistency (Cronbach’s alpha coefficient = 0.87, 95% CI 0.85–0.89) and reproducibility (Concordance Correlation Coefficient = 0.66, 95% CI 0.57–0.74). In Italian children with IBD active disease, female gender and adolescence are associated to a worse QoL, indicating the need of more attention in this subgroup of young patients. IMPACT-III questionnaire is a reliable instrument to measure QoL in Italian children.

scholarly journals The effect of centre volume and procedure location on major complications and mortality from transvenous lead extraction: an ESC EHRA EORP European Lead Extraction ConTRolled ELECTRa registry subanalysis

EP Europace ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. 1718-1728
Author(s):  
Baldeep S Sidhu ◽  
Justin Gould ◽  
Catey Bunce ◽  
Mark Elliott ◽  
Vishal Mehta ◽  
...  
Keyword(s):  
Operating Room ◽  
Surgical Intervention ◽  
High Volume ◽  
Lead Extraction ◽  
Risk Environment ◽  
Catheterization Laboratory ◽  
Major Complications ◽  
Primary Operator ◽  
Significant Difference ◽  
Complications And Mortality

Abstract Aims  Transvenous lead extraction (TLE) should ideally be undertaken by experienced operators in a setting that allows urgent surgical intervention. In this analysis of the ELECTRa registry, we sought to determine whether there was a significant difference in procedure complications and mortality depending on centre volume and extraction location. Methods and results  Analysis of the ESC EORP European Lead Extraction ConTRolled ELECTRa registry was conducted. Low-volume (LoV) centres were defined as &lt;30 procedures/year, and high-volume (HiV) centres as ≥30 procedures/year. Three thousand, two hundred, and forty-nine patients underwent TLE by a primary operator cardiologist; 17.1% in LoV centres and 82.9% in HiV centres. Procedures performed by primary operator cardiologists in LoV centres were less likely to be successful (93.5% vs. 97.1%; P &lt; 0.0001) and more likely to be complicated by procedure-related deaths (1.1% vs. 0.4%; P = 0.0417). Transvenous lead extraction undertaken by primary operator cardiologists in LoV centres were associated with increased procedure-related major complications including death (odds ratio 1.858, 95% confidence interval 1.007–3.427; P = 0.0475). Transvenous lead extraction locations varied; 52.0% operating room, 9.5% hybrid theatre and 38.5% catheterization laboratory. Rates of procedure-related major complications, including death occurring in a high-risk environment (combining operating room and hybrid theatre), were similar to those undertaken in the catheterization laboratory (1.7% vs. 1.6%; P = 0.9297). Conclusion  Primary operator cardiologists in LoV centres are more likely to have extractions complicated by procedure-related deaths. There was no significant difference in procedure complications between different extraction settings. These findings support the need for TLE to be performed in experienced centres with appropriate personnel present.

scholarly journals Risk Factors for Lead-Related Venous Obstruction: A Study of 2909 Candidates for Lead Extraction

2021 ◽  
Vol 10 (21) ◽  
pp. 5158
Author(s):  
Marek Czajkowski ◽  
Wojciech Jacheć ◽  
Anna Polewczyk ◽  
Jarosław Kosior ◽  
Dorota Nowosielecka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inverse Correlation ◽  
High Volume ◽  
Male Gender ◽  
Lead Extraction ◽  
Venous Obstruction ◽  
Vein Wall ◽  
Permanent Atrial Fibrillation ◽  
Related Risk

Background: our knowledge of lead-related venous stenosis/occlusion (LRVSO) remains limited and there is still controversy regarding the risk factors for LRVSO. Venography is mandatory before transvenous lead extraction (TLE). Methods: we performed a retrospective analysis of venograms in 2909 patients (39.43% females, average age 66.90 years) who underwent TLE between 2008 and 2021 at high-volume centers. Results: the severity of LRVSO was likely to be dependent on the number of leads in the system (OR = 1.345; p = 0.003), the number of abandoned leads (OR = 1.965; p < 0.001), the presence of coronary sinus leads (OR = 1.184; p = 0.056), male gender (OR = 1.349; p = 0.003) and patient age at first CIED implantation (OR = 1.008; p = 0.021). The presence of permanent atrial fibrillation (OR = 0.666; p < 0.001) and right ventricular diastolic diameter (OR = 0.978; p = 0.006) showed an inverse correlation with the degree of LRVSO. The combined three-model multivariate analysis provided better prediction of LRSVO using the above-mentioned factors than the CHA2DS2-VASc score. Conclusions: the severity of LRVSO is probably dependent on the mechanical impact of the implanted/abandoned leads on the vein wall, therefore the study has demonstrated the central role of system-/procedure-related risk factors. The thrombotic mechanism may be less important, especially long after implantation, and for this reason the combined prediction model for LRVSO in this study was more effective than the CHA2DS2-VASc score.

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