Coronary Venous Lead Extraction

Cronin, Edmond M.

doi:10.19102/icrm.2017.080604

Cited by 3 publications

(2 citation statements)

References 39 publications

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“…The extraction of coronary sinus leads is reported to be both safe and effective using the standard transvenous methods 4-8 with high success rates, reaching 100% in some case series. 9 Compared to right atrial and right ventricular leads, extraction of CS leads had comparable success and complication rates. 7 Manual traction alone was reported to be sufficient to extract the majority of CS leads that have been implanted up to 4 years.…”

Section: Discussionmentioning

confidence: 99%

917 Hybrid Transvenous and Surgical Approach for the Extraction of Coronary Sinus Leads: A Case Series

Arabia

Bontempi

Cerini

et al. 2022

European Heart Journal Supplements

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Background The rates of cardiac device-related infection have increased substantially over the past years. Transvenous lead extraction is the standard therapy for such cases. In some patients, however, the procedure cannot be completed through the transvenous route alone. A hybrid surgical and transvenous approach may provide the solution in such cases. Methods We present three cases who underwent hybird transvenous and surgical extraction for coronary sinus leads due to infection of CRT-D systems. One patient had an Attain Starfix lead implanted in the coronary sinus. The procedures were performed under local anaesthesia with continuous hemodynamic and transthoracic echocardiographic monitoring. We highlight the characteristics of the patients, the features of the devices, the technical difficulties and the outcomes of the procedures. Results In all cases, the right atrial and right ventricular leads were extracted through the transvenous route. In one patient, they were extracted using regular stylets and manual traction, while in the other two patients, telescoping dilator sheaths (Cook), Tightrail hand-powered mechanical sheaths (Spectranetics) and/or Glidelight Excimer Laser sheaths (Spectranetics) were used. The coronary sinus lead could not be retrieved due to extensive fibrosis after utilizing locking stylets and mechanical dilator sheaths in all 3 cases, in addition to rotational mechanical sheaths and Laser. sheaths in one case, so the so the patients were referred to surgery. Two patients underwent left mini-thoracotomy and one patient underwent midline sternotomy to extract the remaining CS lead. The target vein was identified and ligated, then the fibrosis around the lead was dissected, this was followed by lead retrieval through the surgical incision. The patient who underwent sternotomy suffered from mediastinitis, which required reoperation and mediastinal lavage. There were no complications in the other two patients. All three patients were reimplanted with a new CRT-D device on the contralateral side after the resolution of infection. Conclusion A hybrid surgical and transvenous approach can be complementary in case the transvenous route alone fails to completely extract the coronary sinus lead. The transvenous approach can be used to free the proximal part of the lead, while the distal adhesions can be removed surgically, preferably though a limited thoracic incision.

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Section: Discussionmentioning

confidence: 99%

917 Hybrid Transvenous and Surgical Approach for the Extraction of Coronary Sinus Leads: A Case Series

Arabia

Bontempi

Cerini

et al. 2022

European Heart Journal Supplements

View full text Add to dashboard Cite

show abstract

“…The extraction of coronary sinus leads is reported to be both safe and effective using the standard transvenous methods 4–8 with high success rates, reaching 100% in some case series 9 . Compared to right atrial and right ventricular leads, extraction of CS leads had comparable success and complication rates 7 .…”

Section: Discussionmentioning

confidence: 99%

Hybrid transvenous and surgical approach for the extraction of coronary sinus leads: A case series

Ahmed

Arabia

Valsecchi

et al. 2022

Pacing Clinical Electrophis

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Background Transvenous lead extraction is the standard therapy for cardiac device‐related infection. In some patients, however, a hybrid surgical and transvenous approach may be necessary. Methods and Results We present three cases who underwent transvenous lead extraction for an infected CRT‐D system. In all cases the CS lead could not be retrieved transvenously due to extensive fibrosis. The lead was successfully extracted through left minithoracotomy in two patients and midline sternotomy in one patient. Conclusion In cases where the coronary sinus lead shows severe fibrosis, a transvenous approach can be used to free the proximal part of the lead, while the distal adhesions can be removed surgically through a limited thoracic incision.

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Safety and success of transvenous lead extraction using excimer laser sheaths: a meta-analysis of over 1700 patients

Rinaldi,

Diemberger,

Biffi

et al. 2023

Europace

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Background and Aims While numerous studies have demonstrated favorable safety and efficacy of the excimer laser sheath for transvenous lead extraction (TLE) in smaller cohorts, comprehensive large-scale investigations with contemporary data remain scarce. This study aims to evaluate the safety and performance of laser assisted TLE through a meta-analysis of contemporary data. Methods A systematic literature search was conducted to identify articles which assessed the safety and performance of the SLS II and GlideLight Excimer laser sheaths in TLE procedures between April 1, 2016 and March 31, 2021. Safety outcomes included procedure-related death and major/minor complications. Performance outcomes included procedural and clinical success rates. A random-effects, inverse-variance-weighting meta-analysis was performed to obtain the weighted average of the evaluated outcomes. Results In total, 17 articles were identified and evaluated, including 1,729 patients with 2,887 leads. Each patient, on average, had 2.3 ± 0.3 leads with a dwell time of 7.9 ± 3.0 years. The TLE procedural successes rate was 96.8% (1,440/1,505; 95% CI: [94.9%-98.2%]) per patient and 96.3% (1,447/1,501; 95% CI: [94.8%-97.4%]) per lead, and the clinical success rate per patient was 98.3% (989/1,010, 95% CI: [97.4%-99.0%]). The procedure-related death rate was 0.08% (7/1,729, 95% CI: [0.00%, 0.34%]), with major and minor complication rates of 1.9% (41/1,729; 95% CI: [1.2%-2.8%]) and 1.9% (58/1,729; 95% CI: [0.8%-3.6%]), respectively. Conclusion This meta-analysis demonstrated that excimer laser sheath assisted TLE has high success and low procedural mortality rates. It provides clinicians a reliable and valuable resource for extracting indwelling cardiac leads which require advanced extraction techniques.

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Coronary Venous Lead Extraction

Cited by 3 publications

References 39 publications

917 Hybrid Transvenous and Surgical Approach for the Extraction of Coronary Sinus Leads: A Case Series

917 Hybrid Transvenous and Surgical Approach for the Extraction of Coronary Sinus Leads: A Case Series

Hybrid transvenous and surgical approach for the extraction of coronary sinus leads: A case series

Safety and success of transvenous lead extraction using excimer laser sheaths: a meta-analysis of over 1700 patients

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