Related Experiment Video
Updated: May 13, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Application of intravascular dissection devices for closed chest coronary sinus lead extraction: an interdisciplinary
Milan Lisy1, Angela Kornberger, Eckhard Schmid
1Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Tuebingen, Germany. lisy90@googlemail.com
Insights
Closed chest coronary sinus (CS) lead extraction is safe and effective using intravascular dissection devices. An escalating approach, from manual traction to advanced sheaths, is recommended for high-risk patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Cardiac resynchronization therapy (CRT) use is increasing, leading to more patients needing coronary sinus (CS) lead removal.
- Transvenous lead extraction is becoming more common for various reasons, including infection, dislodgement, and malfunction.
Purpose of the Study:
- To evaluate the outcomes of closed-chest CS lead extraction using intravascular dissection devices.
- To assess the safety and efficacy of different extraction techniques.
Main Methods:
- A retrospective analysis of 41 patients undergoing transvenous CS lead extraction between 2000 and 2011.
- Utilized an escalating approach, starting with manual traction and progressing to locking stylets, mechanical sheaths, and electrosurgical sheaths as needed.
Main Results:
- No deaths or major periprocedural complications occurred in 41 patients.
- Six minor complications were reported, with three requiring surgical intervention.
- Successful extraction was achieved using various methods, with more aggressive techniques associated with longer implantation times and infection.
Conclusions:
- Closed-chest CS lead extraction is a safe procedure with excellent outcomes.
- An escalating strategy, from manual traction to advanced dissection devices, is recommended.
- An interdisciplinary approach is crucial for managing high-risk patients undergoing lead extraction.
Background:
Increasing application of cardiac resynchronization therapy is accompanied by an increase in patients requiring removal of coronary sinus (CS) leads. The aim of this study was to determine outcomes of closed chest CS lead extraction using intravascular dissection devices.
Methods:
Between 2000 and 2011, 41 patients (80.5% men; aged 64.2±13.8 years) underwent transvenous CS lead extraction procedures. Reasons for lead extraction were infection in 9, CS lead dislodgement in 15, lead malfunction, including manufacturer-initiated product recall in 6, phrenic nerve stimulation in 5, combinations of causes in 5, and elective extraction concomitant with generator replacement for battery depletion in 1.
Results:
In addition to 24 isolated CS lead extractions, we performed 17 multiple lead extractions (2 to 4 leads) after a mean of 30.6±32.5 months. The time elapsed from implantation was 4.6±9.1 months for isolated CS and 42.6±32.4 months for multiple lead extractions. Extraction by direct manual traction was feasible in 13 patients by locking stylets in 6. Escalation to mechanical sheaths was required in 17 patients and to electrosurgical sheaths in 5. More aggressive methods were associated with longer implantation times and positive infection status. No deaths or major periprocedural complications occurred. Six minor postprocedural complications, of which three were surgically related, occurred in 5 patients.
Conclusions:
Closed chest CS lead extraction can be safely performed with excellent results. We recommend an escalating approach from isolated manual traction over locking stylets to mechanical sheaths and, eventually, electrosurgical dissection devices. The application in mainly high-risk patients demands an interdisciplinary approach to enhance safety and limit morbidity and death.
