Influence of lead extraction on tricuspid valve function

Abstract

Abstract Background Transvenous lead extraction (TLE) is the main part of contemporaneous lead management strategy. Connecting tissue scar surrounding the lead and binding of it to heart structures creates risk venous or cardiac wall injury with severe bleeding or severe damage of tricuspid valve (TV) Purpose The aim of the study was to determine circumstances of appearance and risk factors of TV damages (TVD) and the influence of TVD on long term mortality Methods This post-hoc analysis used clinical data of 2693 patients who underwent transvenous lead extraction between 2007and 2021 in three high-volume center. Based on the transthoracic (TTE) and transesophageal echocardiography (TEE), the function of the tricuspid valve before and after TLE was compared, and the potential risk factors for TVD as well as the long-term survival of patients after TLE were assessed Results In most procedures (82.0%), TLE had no effect on TV function, in 9.5% different severity of tricuspid regurgitation (TR) was noted, significant deterioration occurred in 2.5% patients. The most important risk factors of TV damage were: young age of patient, long implant duration, multiple leads, abnormal heart lead route and procedure complexity. TVD was often seen in patients with normal left ventricular ejection fraction (LVEF >50% in 73,1% patients), strong adhesion of the lead with the heart structures (46,4%), and abnormal loop of the lead irritated TV (28,8%). The long-term mortality of patients with significant worsening of tricuspid valve function during TLE was comparable to that in patients without TVD (6,0% vs 14,4%; p=0,06). Conclusions Significant tricuspid valve dysfunction during TLE is relatively rare in an experienced center. The main echocardiographic predictors of significant TVD during TLE is the presence of intense connective tissue adhesions binding the lead to the heart structures related to long lead dwell tome. Significant TLE related TVD has no clear influence on long-term survival after lead extraction. Funding Acknowledgement Type of funding sources: None.