Abstract 12854: Strategies and Outcomes of Patients With Severely Reduced Ejection Fraction (≤15%) Undergoing Transvenous Lead Extraction: A Single Center Experience

Abstract

Introduction: Patients with severely reduced EF (SREF≤15%) are deferred from transvenous lead extraction (TLE) due to fears of intraoperative hemodynamic collapse. When these patients require lead extraction, their management options are limited, and they suffer high morbidity and mortality. Left ventricular assist devices may provide intraoperative hemodynamic support and facilitate TLE, enabling life-saving interventions. Hypothesis: We present our single-center experience performing TLE in 245 patients with SREF. Additionally, we report the outcomes of 8 patients who received left ventricular support during TLE. Methods: Between January 2008-January 2022, we performed TLE on 245 patients with Stage D heart failure, SREF, and Class I or II indications for extraction. Primary (clinical success and in-hospital mortality) and secondary outcomes (length of stay [LOS] and procedure-associated complications) were compared between SREF patients and control. A subgroup analysis was performed in the SREF group to evaluate the outcomes of eight patients who underwent extraction with LV assist devices. Results: Overall clinical success was high (97.6%), and mortality was low (5.3%). There were no statistically significant differences in primary outcomes associated with extraction between groups. Similarly, there were no significant differences in procedural complications between groups. In the SREF group, there were no significant differences in outcomes between the eight patients undergoing TLE with LV assist devices and cases that did use LV assist devices. Conclusions: Lead extraction in patients with SREF can be performed safely and effectively. Adopting a few simple steps, including initiating LV support, can overcome myocardial impairment in patients who decompensate.