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

Roberto, Maurizio; Sicuso, Rita; Manganiello, Sabrina; Catto, Valentina; Salvi, Luca; Nafi, Matteo; Casella, Michela; Rossi, Fabiana; Grillo, Francesco; Saccocci, Matteo; Gasperetti, Alessio; Cervellione, Rosario; Carcione, Davide; Alamanni, Francesco; Tondo, Claudio; Russo, Antonio Dello

doi:10.1016/j.ijcard.2018.12.074

Cited by 12 publications

(27 citation statements)

References 22 publications

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“…If excimer laser energy is not applied, major complications other than tear of the SVC and anonymous vein seem to be more frequent [ 18 ]. The available guidelines and medical literature describe all forms of cardiovascular wall tear but not worsening TR after TLE [ 1 , 2 , 3 , 4 , 5 , 16 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…The problem of TVD was omitted in the older guidelines [ 1 , 2 , 3 , 4 ] and addressed only just in the recent ones [ 4 , 5 ]. There are several reports concerning the role of cardiac surgery and cardiac anesthesiology in the management TLE-related cardiovascular injuries [ 8 , 9 , 10 , 11 , 12 ] and TLE effectiveness [ 13 , 14 , 15 , 16 , 17 , 18 ], but there is no comprehensive investigation of cardiac laceration/vascular walltear (CVWT) and TVD as major and minor complications of lead extraction. Some investigators reported TR increase without any reference to minor and major TLE complication [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers

Tułecki

Polewczyk

Jacheć³

et al. 2021

IJERPH

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Background: Transvenous lead extraction (TLE) is the preferred management strategy for complications related to cardiac implantable electronic devices. TLE sometimes can cause serious complications. Methods: Outcomes of TLE procedures using non-powered mechanical sheaths were analyzed in 1500 patients (mean age 68.11 years; 39.86% females) admitted to two high-volume centers. Results: Complete procedural success was achieved in 96.13% of patients; clinical success in 98.93%, no periprocedural death occurred. Mean lead dwell time in the study population was 112.1 months. Minor complications developed in 115 (7.65%), major complications in 33 (2.20%) patients. The most frequent minor complications were tricuspid valve damage (TVD) (3.20%) and pericardial effusion that did not necessitate immediate intervention (1.33%). The most common major complication was cardiac laceration/vascular tear (1.40%) followed by an increase in TVD by two or three grades to grade 4 (0.80%). Conclusions: Despite the long implant duration (112.1 months) satisfying results without procedure-related death can be obtained using mechanical tools. Lead remnants or severe tricuspid regurgitation was the principal cause of lack of clinical and procedural success. Worsening TR(Tricuspid regurgitation) (due to its long-term consequences), but not cardiac/vascular wall damage; is still the biggest TLE-related problem; when non-powered mechanical sheaths are used as first-line tools.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers

Tułecki

Polewczyk

Jacheć³

et al. 2021

IJERPH

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“…Furthermore, rapid surgical intervention is key as irreversible neurological damage occurs within 5 to 10 minutes of cardiac tamponade [10]. In addition to the serious injuries being seen elsewhere in the literature, our conclusion that a cardiothoracic surgeon is still a vitally important member of the laser lead extraction team is also supported by the research of other groups [14][15][16][17]. It has been noted that the involvement of a surgeon may increase costs, but that this is outweighed by the bene t to the patient [17].…”

Section: Discussionmentioning

confidence: 70%

Is Cardiopulmonary Bypass Standby Still Required for Laser Lead Extractions?

Volk¹,

Verghis²,

Ikegami³

et al. 2021

Preprint

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Objective: Over the last two decades there has been an increase in the number of cardiac implantable electronic devices and consequently, there has also been an increased need for lead extractions. Fibrotic attachments develop between the lead and the venous and cardiac structures that may require the use of a laser to mobilize the lead. Cardiothoracic surgeons (CTS) have traditionally provided backup for surgical emergencies for these extractions. This study evaluates the surgical outcomes of patients undergoing transvenous laser lead extractions (TLE) and determines if CTS are still needed for backup.Methods: A retrospective review of consecutive patients undergoing laser lead extractions at a single academic center. Lead extractions using only laser sheaths were analyzed. The clinical characteristics, complications, and mortality of the patients were evaluated.Results: One hundred and twenty-one patients underwent TLEs from January 1st, 2014 to December 31st, 2018. The majority were male (N=80, 66.1%), and the average age was 66.48 ± 14 years. The indication for removal was either laser lead malfunction or infection. A total of 30 patients (24.8%) had complications postoperatively including wound hematomas, superficial infections, and arrhythmias. The average length of stay was 9±12 for all the patients in the study. 2 patients (1.6%) had injuries that required emergency surgical repair with injuries to the posterior superior vena cava and right ventricle. Both patients survived the initial injury with one patient was discharged home on day 4 and the other succumbing to his injuries on postoperative day 20.Conclusion: Although the incidence of surgical emergencies is rare the morbidity and mortality for TLE require that surgical backup be available.

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“…Published literature has suggested that factors such as older age, longer lead‐dwell time, and lower body mass index (BMI) are associated with increased risk of complications during LEs . The majority of catastrophic complications occur due to a vascular tear or cardiac perforation, thus prompt availability of a cardiac surgery team can be critical . However, there is no consensus as to which LE procedures should be performed in the presence of the surgical team.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7] The majority of catastrophic complications occur due to a vascular tear or cardiac perforation, thus prompt availability of a cardiac surgery team can be critical. [8][9][10] However, there is no consensus as to which LE procedures should be performed in the presence of the surgical team. A previous retrospective study has suggested a risk stratification scheme using lead age as the sole parameter with a prospective validation of this approach reported recently.…”

Section: Introductionmentioning

confidence: 99%

RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol)

Afzal

Daoud

Matre

et al. 2019

Cardiovasc electrophysiol

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Background An internal risk stratification algorithm was developed to decrease the risk of major adverse cardiac events (MACEs) during lead extractions (LEs). Objective To report upon the impact of a risk stratification algorithm (RISE [RIsk Stratification prior to lead Extraction] protocol) on outcomes of LEs in a high‐volume center. Methods A retrospective review of a prospectively maintained LEs database was performed to identify features associated with MACEs. On the basis of the retrospective data, the RISE protocol differentiated LEs procedures into “High” and “Low” risk for occurrence of MACEs. High‐risk LEs included dual‐coil defibrillator lead (≥3 years), pacemaker and single‐coil lead (≥5 years), and any StarFix coronary sinus lead. During the prospective evaluation of the RISE protocol, “High‐risk” LEs were performed in an operating room (OR) or hybrid laboratory with the cardiac anesthesiologist, OR nursing team, perfusionist in the room, and a cardiac surgeon on the premises. “Low‐risk” LEs were performed in the electrophysiology (EP) laboratory with anesthesia provided by EP nursing team. The preintervention (pre‐RISE) and postintervention (post‐RISE) group spanned 19 and 40 months and consisted of 449 (632 leads) and 751 patients (1055 leads), respectively. The primary outcome of MACEs in the two groups was compared. Results Protocol compliance was 100%. The primary outcome of MACEs occurred in 15 patients (3.34%) before and 12 (1.6%) after implementation of the RISE protocol (P = .04). Conclusion RISE identified a low‐risk group where minimal resources are needed and allowed for rapid intervention in the high‐risk group that reduced the consequences of MACEs.

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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

Cited by 12 publications

References 22 publications

A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers

A Study of Major and Minor Complications of 1500 Transvenous Lead Extraction Procedures Performed with Optimal Safety at Two High-Volume Referral Centers

Is Cardiopulmonary Bypass Standby Still Required for Laser Lead Extractions?

RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol)

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