Novel extraction technique of retained pacemaker and defibrillator lead during heart transplantation

Eriko Hasumi,Issei Komuro,Minoru Ono,Kan Nawata,Haruo Yamauchi,Toshiya Kojima,Katsuhito Fujiu,Osamu Kinoshita,Xianwu Cheng

doi:10.1371/journal.pone.0203172

Abstract

BackgroundRemoval of cardiac implantable electronic devices (CIEDs) by manual traction during orthotopic heart transplantation (OHT) sometimes results in retained lead fragments. Moreover, abandoned leads and retained lead fragments are a contraindication for magnetic resonance imaging (MRI) and may be a cause of CIED infection.ObjectiveTo eliminate complications of retained lead fragments, we completely removed residual leads using an excimer laser sheath technique during OHT. We report our clinical experience and high success rate of lead extraction using the excimer laser sheath compared with manual traction during OHT.Methods and resultsWe obtained data on 84 consecutive patients receiving OHT between August 2007 and August 2017. Thirty-nine of 84 patients had undergone CIED implantation before OHT and removal of all their leads was attempted during OHT. From 2007 to 2014, defibrillator and pacemaker leads were extracted by manual traction in all patients (N = 22). After 2015, all leads were extracted with the excimer laser sheath, and surgical assistance was prepared for the procedure (N = 17). Complete procedural success was achieved in 100% of patients in the excimer laser group and 77% of patients in the manual traction group.ConclusionExtraction of abandoned leads using the excimer laser sheath system during OHT is novel and safe technique, and has a higher success rate than extraction using manual traction during OHT.

Highlights

Implantations of an implantable cardioverter defibrillator (ICD) and a cardiac resynchronization therapy defibrillator (CRTD) have been demonstrated to reduce sudden death and improve total mortality in patients awaiting orthotopic heart transplantation (OHT) [1]
We report our clinical experience and high success rate of lead extraction using the excimer laser sheath compared with manual traction during OHT
Surgical operators have attempted to remove abandoned leads originating from these devices using manual tractions during OHT, many cases (19 to 39% of patients after OHT) experienced retention of leads from devices that had been implanted for a long period [2, 3]

Summary

Introduction

Implantations of an implantable cardioverter defibrillator (ICD) and a cardiac resynchronization therapy defibrillator (CRTD) have been demonstrated to reduce sudden death and improve total mortality in patients awaiting orthotopic heart transplantation (OHT) [1]. The presence of retained leads was not associated with mortality rate within an observed period They reported cases of residual lead erosion into the mediastinum and embolism in the pulmonary artery [3]. Two other cases have been reported to have retained lead fragments that induced asymptomatic pulmonary embolism and perforation of the left ventricle [4] To prevent these complications and future potential hazards relating to retained leads, we attempted to perform a complete extraction of implanted leads using the excimer laser sheath system during OHT. Removal of cardiac implantable electronic devices (CIEDs) by manual traction during orthotopic heart transplantation (OHT) sometimes results in retained lead fragments. Abandoned leads and retained lead fragments are a contraindication for magnetic resonance imaging (MRI) and may be a cause of CIED infection

Methods

Results

Conclusion