PO-02-057 CHARACTERISTICS, INDICATIONS, AND OUTCOMES OF ELECTIVE OPEN CHEST LEAD EXTRACTIONS

Abstract

While transvenous lead extraction (TLE) has become a pillar of modern lead management, it still carries significant risk of morbidity and mortality – including need for emergent sternotomy for management of complications. There is little data available on patients who undergo elective open-chest lead extraction (OLE) rather than TLE. We describe the characteristics, indications, and outcomes of patients undergoing elective OLE. We collected all data from Jan 2010 to Oct 2022 on patients referred to our center for TLE who subsequently underwent elective OLE. Patient characteristics, procedural outcomes, complications, and survival at follow-up were evaluated. Out of 985 patients referred for TLE, 12 patients (1.2%) underwent elective OLE. Indications for elective OLE included need for valve repair or replacement (5/12, 42%), failed previous TLE with amputated leads (3/12, 25%), RV lead perforation requiring repair (2/12, 17%) and large lead vegetations > 2.5 cm (2/12, 17%). Mean indwelling time for the oldest lead was 17.8 ± 12.6 years. A mean of 3.4 ± 1 leads were removed at time of procedure with 100% success rate. Five patients (42%) had indwelling leads > 20 years and 4 (33%) patients had prior TLE. Six patients (50%) had epicardial pacemakers implanted at time of OLE, two patients (17%) had leadless pacemakers implanted in the post-op period, and two did not require device re-implant. All patients survived at 30-day follow-up and 7/8 (87%) patients survived at 1 year follow-up with 1 patient passing after 30 days due to mediastinitis from an infected epicardial defibrillator patch. In our series, elective OLE has a high success rate and excellent short-term survival. For patients with need for concomitant cardiothoracic surgery, prior failed TLE, or at high risk of complications from TLE, elective OLE should be considered as an alternative.