Abstract
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.
Highlights
Transvenous lead extraction (TLE) is considered an integral part of the management strategy for complications related to the presence of cardiac implantable electronic devices (CIED) [1,2,3,4,5].Due to the foreign body reaction and extensive fibrotic scarring around the leads [6,7], TLE can sometimes cause severe damage to the veins and heart as manifested by bleeding into the mediastinum or right pleural cavity, or acute pericardial effusion depending on the location of the tear [1,2,3,4,5,8,9,10,11,12].Another problem we face in TLE is the real risk of tricuspid valve damage (TVD) with worsening tricuspid regurgitation (TR)
Complete procedural success was obtained in 96.13%, partial radiographic success in 3.07%, whereas clinical success in
The present study shows that an injury to structures other than the right atrium (RA) (CS, superior vena cava (SVC), connection of RA to inferior vena cava (IVC)) was associated with a higher drop in arterial blood pressure and CO2 in exhaled air and a much higher blood loss than in cardiac tamponade caused by RA damage
Summary
Transvenous lead extraction (TLE) is considered an integral part of the management strategy for complications related to the presence of cardiac implantable electronic devices (CIED) [1,2,3,4,5].Due to the foreign body reaction and extensive fibrotic scarring around the leads [6,7], TLE can sometimes cause severe damage to the veins and heart as manifested by bleeding into the mediastinum or right pleural cavity, or acute pericardial effusion depending on the location of the tear [1,2,3,4,5,8,9,10,11,12].Another problem we face in TLE is the real risk of tricuspid valve damage (TVD) with worsening tricuspid regurgitation (TR). Transvenous lead extraction (TLE) is the preferred management strategy for complications related to cardiac implantable electronic devices. 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. Minor complications developed in 115 (7.65%), major complications in 33 (2.20%)
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