Cardiovascular implantable electronic device lead extraction

Sadek, Mouhannad M.; Goldstein, William; Epstein, Andrew E.; Schaller, Robert D.

doi:10.1097/hco.0000000000000247

Cited by 6 publications

References 29 publications

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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

Kšela

Prevolnik

Racman

2020

Interactive CardioVascular and Thoracic Surgery

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

Kšela

Prevolnik

Racman

2020

Interactive CardioVascular and Thoracic Surgery

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Cardiac Implantable Electronic Device Lead Extractions

Fitzmartin¹,

Kacha²

2019

Cardiac Anesthesia: A Problem-Based Learning Approach

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Cardiac implantable electronic devices (CIEDs) are used for an increasing range of indications. With a broader range of indications, CIEDs are being implanted in increasing numbers. They are being used in older patients as well as patients with more comorbidities. As expected with these trends, the need for device extraction for a variety of reasons has steadily grown as well. These leads can often be removed via simple traction, but other techniques have been developed for circumstances where removal is more complex. To perform this procedure safely, a team-based approach is required, as is the ability to anticipate consequences of complications for each of the different methods of removal. A gold standard method has not been identified for transvenous lead extraction, but rather one has a toolbox of methods at their disposal. In this chapter, indications for lead removal, extraction techniques and devices, as well as potential complications are reviewed.

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Costs and complications associated with transvenous lead reoperation in cardiac implantable electronic devices

Griffiths

Amorosi

Jacobsen

et al. 2020

Cardiovasc electrophysiol

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Background: Cardiac implantable electronic device transvenous (TV) lead reoperations are projected to increase, and robust economic data are needed to assess the resulting financial impact and the cost-effectiveness of prevention and treatment strategies. This study estimates Medicare costs, and describes patterns of complications, in patients who underwent TV lead reoperation. Methods and Results: Medicare data (2010-2014) were used to identify patients who underwent TV lead reoperation. Cumulative costs to Medicare, and rates of infection and mechanical complications were calculated from 180 days before, to 180 days after, lead reoperation. Multivariate analysis was used to estimate adjusted costs, and to examine the impact of complications on medical resource use and costs. There were 1691 patients, 63.2% of whom underwent inpatient lead reoperation. Overall, the mean age was 78.2 years, 39.6% were female, and 92.3% were white. The mean cumulative cost was $36 199 (95% confidence interval [CI], $31 864-$40 535) for TV lead repositioning, $27 701 (95% CI, $19 869-$35 534) for repair, and $54 442 (95% CI, $51 651-$57 233) for removal. Underlying infection was associated with increased odds of inpatient reoperation and of lead removal, as well as longer length of stay and higher costs. Conclusions: The economic consequences of TV lead reoperation are substantial. Strategies aimed at reducing reoperation, particularly lead removal, are likely to result in considerable cost offsets. K E Y W O R D S cardiac implantable electronic device, cost, reoperation, transvenous leads

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Cardiovascular implantable electronic device lead extraction

Abstract: Improvement in technology, alternative routes of extraction and preprocedural imaging continue to add to procedural efficacy and reduce complication rates of lead extraction.

Cited by 6 publications

References 29 publications

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

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

Cardiac Implantable Electronic Device Lead Extractions

Costs and complications associated with transvenous lead reoperation in cardiac implantable electronic devices

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