9. Incidence of tricuspid valve regurgitation following pacemaker/defibrillator lead extraction

Abstract

Despite advanced sterile techniques in cardiac device implantations, long-term complications such as wound infections and/or lead-induced endocarditis can develop mandating lead and device extraction. It has been suggested that lead extraction carries a risk of new-onset Tricuspid Regurgitation (TR), or a deterioration of a formerly known regurgitant valve. Yet, there is no enough scientific evidence to our knowledge to back this claim. In this study we aim to explore the risk of TR following lead extraction.We conducted a retrospective chart review in 113 patients whom underwent lead extraction at Prince Sultan Cardiac Center in Saudi Arabia during the period of Jan, 2002 to Jul, 2015. Six patients underwent lead extraction twice, making the total number of extractions to be 119. Of this study cohort, we include 52 cases who had Tricuspid valve function evaluation via Transthoracic Echocardiography (TTE) prior to and after device and lead extraction. TR severity was assessed using a grading system as the following; normal, mild, mild-to-moderate, moderate-to-severe, and severe. Worsening or improvement by more than 1 grade was considered clinically significant. TR following lead extraction was examined over a median of 5 months. Of the 52 cases included in this study, 37 (71.2%) were males and 15 (28.8%) were females, with a mean age of 46 (SD = 18) years. Eleven patients (21.2%) experienced worsening of TR (3 had normal functioning valves before extraction, and 8 were known to have TR prior to extraction), 2 (3.8%) had improvement, and the majority (75.0%) did not experience any significant changes. Compared with those who had no change, average lead duration was higher in the worsening TR group (67.2 vs. 27.9 months). A lead-attached vegetation was detected in 4 out of the 11 patients with TR. Lead type (High-voltage vs. Pacing) was not predictive of TR, 5 (45.5%) of the patients in the worsening group had high-voltage leads, while the remaining (54.5%) had pacing leads across the valve.Our study being a simple descriptive study could not find overwhelming evidence to support the claim that there is an elevated risk of new onset TR or deterioration of a regurgitant valve following pacemaker/defibrillator lead extraction. However, our study being a simple observational study with a considerably small sample size may influence the findings. Lack of appropriate control group in this study is a limitation in appraising the hypothesis. As there is scarcity of data in this important area of cardiac research, our findings should prompt motivation for larger and well controlled cohort studies.