Safety and efficacy of transvenous lead extraction in octogenarians using powered extraction sheaths

Bürger, H. C.; Hakmi, Samer; Petersen, Johannes; Yıldırım, Yalın; Choi, Yeong‐Hoon; Willems, Stephan; Reichenspurner, Hermann; Ziegelhoeffer, Tibor; Pecha, Simon

doi:10.1111/pace.14195

Cited by 7 publications

(17 citation statements)

References 31 publications

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“…This is in line with the literature, where a comparable success rate was found in patients treated with mechanical dilatation, [17][18][19] with laser extraction and with both techniques, irrespective of older age. [4][5][6][7] Previous studies by Kutarski et al 17 and Jacheć et al 18 with larger study groups compared with our study, demonstrated high effectiveness of TLE using non-powered mechanical tools, suggesting the need of only "simple" mechanical tools in elderly patients, probably due to the absence of significant calcification of connecting tissue scar surrounding leads in octogenarians compared to younger patients. 17,18 However, it should be noted that in our study, the mean implant duration was 112 ± 77 months (range 12-377) and patients with recently implanted leads (implant duration < 12 months) or patients with implant duration > 12 months whose leads had been removed by only manual traction with or without locking stylet were excluded.…”

Section: Lead Extraction In Octogenarian Patients: Effectiveness and ...supporting

confidence: 59%

“…17,18 However, data on lead extraction with a long lead dwell time requiring powered extraction tools are limited in this special patient population. [4][5][6][7] The present multicenter study showed high rates of complete lead extraction and clinically successful lead removal per lead exclusively using the Evolution RL system with ancillary tools as the first-line approach. This is in line with the literature, where a comparable success rate was found in patients treated with mechanical dilatation, [17][18][19] with laser extraction and with both techniques, irrespective of older age.…”

Section: Lead Extraction In Octogenarian Patients: Effectiveness and ...mentioning

confidence: 62%

“…Of note, in the study by Burger et al 7 laser sheaths were used as firstline approach in all cases, and rotational mechanical sheaths were used after laser technique failure in 7% of patients.…”

Section: Lead Extraction In Octogenarian Patients: Effectiveness and ...mentioning

confidence: 99%

“…Especially, studies investigating TLE using powered extraction tools are limited in this elderly patient population. [4][5][6][7] In recent years, the safety and effectiveness of bidirectional rotational TLE tools (Evolution RL; Cook Medical, Bloomington, IN) for the extraction of chronically implanted leads were established in large-scale, retrospective, and prospective multicenter experiences. [8][9][10][11][12] However, data on safety and efficacy of TLE in octogenarians with a long lead dwell time, using exclusively the bidirectional rotational mechanical sheaths are lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Outcomes of TLE are well reported in the general population; however, in octogenarians there are only few studies. Especially, studies investigating TLE using powered extraction tools are limited in this elderly patient population 4–7 . In recent years, the safety and effectiveness of bidirectional rotational TLE tools (Evolution RL; Cook Medical, Bloomington, IN) for the extraction of chronically implanted leads were established in large‐scale, retrospective, and prospective multicenter experiences 8–12 .…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths

Migliore

Pittorru

Dall’Aglio

et al. 2023

Pacing Clinical Electrophis

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BackgroundOutcomes of transvenous lead extraction (TLE) are well reported in the general population, However, data on safety, efficacy of TLE in octogenarians with a long lead dwell time, using powered extraction tools are limited. The aim of this multicenter study was to evaluate the safety, effectiveness of TLE in octogenarians using the bidirectional rotational mechanical sheaths and mid‐term outcome after TLE.MethodsThe study population comprised 83 patients (78.3% male; mean age 85 ± 3 years; [range 80–94 years]) with 181 target leads. All the leads (mean implant duration 112 ± 77 months [range 12–377]) were extracted exclusively using the Evolution RL sheaths (Cook Medical, Bloomington, IN, USA).ResultsThe main indication for TLE was infection in 84.3% of cases. Complete procedural success rate, clinical success rate, per lead were 93.9% and 98.3%, respectively. Failure of lead extraction was seen in 1.7% of leads. The additional use of a snare was required in 8.4% of patients. Major complications occurred in one patient (1.2%). Thirty‐day mortality after TLE was 6%. During a mean time follow‐up of 22 ± 21 months, 24 patients (29%) died. No procedure‐related mortality occurred. Predictors of mortality included ischemic cardiomyopathy (HR 4.35; 95% CI 1.87–10.13; p = .001), left ventricularejection fraction ≤35% (HR 7.89; 95% CI 3.20–19.48; p < .001), and TLE for systemic infection (HR 4.24; 95% CI 1.69–10.66; p = .002).ConclusionsAt experienced centers bidirectional rotational mechanical sheaths combined with different mechanical tools and femoral approach allowreasonable success and safety in octogenarian with long lead dwell time. Patient's age should not influence the decision to extract or not the leads, although the 30‐day and mid‐term mortality are significant, especially in the present of specific comorbidities.

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Section: Lead Extraction In Octogenarian Patients: Effectiveness and ...supporting

confidence: 59%

Section: Lead Extraction In Octogenarian Patients: Effectiveness and ...mentioning

confidence: 62%

Section: Lead Extraction In Octogenarian Patients: Effectiveness and ...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths

Migliore

Pittorru

Dall’Aglio

et al. 2023

Pacing Clinical Electrophis

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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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Laser lead extraction in octo‐ and nonagenarians. A subgroup analysis from the GALLERY registry

Pecha

Chung

Bürger

et al. 2023

Cardiovasc electrophysiol

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IntroductionIn an aging population with cardiac implantable electronic devices, an increasing number of octo‐ and even nonagenarians present for lead extraction procedures. Those patients are considered at increased risk for surgical procedures including lead extraction. Here, we investigated safety and efficacy of transvenous lead extraction in a large patient cohort of octo‐ and nonagenarians.Methods and ResultsA subgroup analysis of all patients aged ≥80 years (n = 499) in the German Laser Lead Extraction Registry (GALLERY) was performed. Outcomes were compared to the nonoctogenarians from the registry. Primary extraction method was Laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. An analysis of patient‐ and device characteristics, as well as an assessment of predictors for adverse events via multivariate analyses was conducted. Mean patients age was 84.3 ± 3.7 years in the octogenarians group and 64.1 ± 12.4 years in the nonoctogenarians group. The median lead dwell time was 118.0 months (78; 167) and 92.0 months [60; 133], p < .001 in the octogenarians and nonoctogenarians group, respectively. Clinical procedural success rate was achieved in 97.6% of the cases in octogenarians and 97.9% in nonoctogenarians (p = .70). Overall complication rate was 4.4% in octogenarians and 4.3% in nonoctogenarians (0.91). In octogenarians procedure‐related mortality was 0.8% and all‐cause in‐hospital mortality was 5.4%, while in nonoctogenarians, procedure related and all‐cause in‐hospital mortality were 0.5% and 3.1%, respectively. A body mass index (BMI) <20 kg/m2, was the only statistically significant predictor for procedure‐related complications in octogenarians, while systemic infection, BMI ≤20 kg/m2, procedural complications and chronic kidney disease were predictors for in‐hospital mortality.ConclusionsLaser lead extraction in octo‐ and nonagenarians is safe and effective. BMI ≤20 kg/m2 was the only statistically significant predictor for procedural complications. According to our data, advanced age should not be considered as contraindication for laser lead extraction.

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Safety and efficacy of transvenous lead extraction in octogenarians using powered extraction sheaths

Cited by 7 publications

References 31 publications

Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths

Outcomes of transvenous lead extraction in octogenarians using bidirectional rotational mechanical sheaths

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

Laser lead extraction in octo‐ and nonagenarians. A subgroup analysis from the GALLERY registry

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