Laser-assisted extraction of pacemaker and defibrillator leads: Surgical experience in a single tertiary center

Abstract

Laser assistance in pacemaker and defibrillator leads extractions (LALE) has dramatically reduced the need for conventional open surgery. However, these procedures carry a risk of vascular and cardiac injuries which are often fatal if surgical intervention is slightly delayed. Though the role of the cardiac surgeon in this instance remains undefined. We sought to analyze the results of LALE performed by a surgical team. From July 2014 to March 2019, 58 consecutive patients underwent LALE in our department. Clinical data were prospectively collected. All procedures were performed in operating room under video-fluoroscopy guidance with continuous invasive haemodynamic monitoring and transesophagal echocardiographic assessment. The study population was 40 males and 18 females aged 63 [51–73] with a median Euroscore II of 4.4 [1.5–11.4]. There were 27 intracardiac defibrillators and 31 pacemakers with a median time from lead implantation of 8 [5–13] years, and a mean number of 2.3 ± 1.0 leads extracted per procedure. Indications for LALE were endocarditis in 23 cases (40%), device pocket infection in 15 cases (26%), leads dysfunction in 17 cases (29%) and other causes in 3 cases (5%). Success rate of complete leads removal was 95.4%. Thirty-day mortality was 3.4% ( n = 2). These two deaths were related to septic pulmonary embolism and refractory cardiogenic shock. Two dilacerations of the superior vena cava and right atrial wall occurred intra-operatively and were managed successfully by immediate median sternotomy. Three other patients (5.2%) had pericardial effusion, only one requiring urgent percutaneous drainage. At 12 and 36 months, global survival was 93 ± 3% and 90 ± 4%, respectively. LALE is an efficient technology for leads removal, with excellent mid-term results even in high-risk and/or septic patient. Complications are not infrequent but they can be less disastrous if they happened in a surgical environment.