Outcomes and costs associated with two different lead-extraction approaches: a single-centre study

Area of Science:

• Cardiology
• Medical Devices
• Interventional Procedures

Background:

• Transvenous lead extraction (TLE) is a critical procedure for managing cardiac implantable electronic device complications.
• Stepwise approaches to TLE aim to optimize success rates and minimize complications.
• Comparing different sheath technologies, such as laser-assisted versus mechanical polypropylene, is essential for refining TLE protocols.

Purpose of the Study:

• To compare the outcomes and costs of a stepwise transvenous lead extraction (TLE) approach using laser-assisted sheaths versus mechanical polypropylene sheaths.
• To evaluate the effectiveness, safety, and cost-efficiency of different sheath technologies in TLE.

Main Methods:

• Prospective study comparing a polypropylene sheath-first approach (Group A) with a historical laser-assisted sheath approach (Group B) for TLE.
• Patients requiring sheath assistance were analyzed for procedural success, complications, radiation exposure, and costs.
• Group B patient numbers were adjusted to match Group A patients needing sheaths for comparison.

Main Results:

• Radiological and clinical success rates were similar between the overall groups.
• In patients requiring sheath assistance, laser sheaths demonstrated higher radiological and clinical success rates with lower radiation exposure (P<0.001 and P=0.01, respectively).
• Complication rates were similar, but two deaths occurred in the laser group; polypropylene sheaths were more cost-effective (P=0.002).

Conclusions:

• Laser-assisted TLE is more effective than polypropylene sheath-assisted TLE.
• Polypropylene sheaths are associated with fewer complications and are more cost-effective.
• The choice of sheath technology in TLE involves balancing effectiveness, safety, and cost.