PO-02-055 CALCIFICATION AND VENOUS OCCLUSION DETECTED BY COMPUTED TOMOGRAPHY IS ASSOCIATED WITH GREATER NEED FOR MECHANICAL SHEATH UTILIZATION DURING TRANSVENOUS LEAD EXTRACTION

Abstract

The ideal choice of laser or mechanical sheath use for lead extraction is likely dependent on patient-specific factors. It is unknown whether imaging characteristics detected from cardiac computed tomography (CT) can be used to guide optimal extraction sheath choice. To assess CT characteristics associated with need to upgrade a laser sheath to a mechanical sheath during lead extraction. All consecutive patients undergoing transvenous lead extraction from January 2018 to February 2022 were analyzed, utilizing the UC San Diego Lead Extraction Database. Included patients underwent cardiac-gated chest CT scans with intravenous contrast. All scans were reviewed by a single radiologist to assess presence of calcification and venous occlusion. Lead extraction was performed per standard institutional protocol with initial use of a laser sheath and upgrade to mechanical sheath as needed. Multivariable logistic regression analysis was performed to identify predictors of mechanical sheath use, as a marker of extraction difficulty. A total of 343 patients were retrospectively analyzed. Mean age of the study population was 63.8 ± 15.4 years; 71% were male. Mean lead dwell-in duration was 102.7 ± 68.4 months. In multivariable logistic regression analysis, calcification and venous occlusion were associated with higher need for mechanical sheath use during lead extraction [(odds ratio: 5.3, p <0.001, 95% CI: 2.6-10.8) and (odds ratio: 3.7, p <0.001, 95% CI: 1.9-7.3)], respectively. Patients with calcification or venous occlusion detected by chest CT are each five and three times more likely to require a mechanical sheath during lead extraction.