[Concurrent Surgical Venous Repair during Laser-assisted Pacemaker Lead Extraction]

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Innovation

Background:

• Pacemaker device infection is a significant complication requiring complete lead and generator removal.
• Transvenous laser-assisted extraction is a newer technique for pacemaker lead removal with good outcomes.
• Catastrophic complications, including vascular damage, can occur during lead extraction, sometimes necessitating surgical repair.

Purpose of the Study:

• To report two cases of complex pacemaker lead extraction with superior vena cava and innominate vein reconstruction.
• To highlight the utility of bovine pericardium in vascular repair during lead extraction.
• To advocate for a hybrid approach in managing pacemaker lead infections with significant vascular involvement.

Main Methods:

• Transvenous laser-assisted extraction was performed for pacemaker leads.
• Surgical reconstruction of the superior vena cava and innominate vein was achieved using bovine pericardium.
• A hybrid approach combining minimally invasive extraction with open surgical repair via median sternotomy was employed.

Main Results:

• Successful complete lead extraction was achieved in both reported cases.
• Vascular reconstruction using bovine pericardium was effective in managing complications during extraction.
• The hybrid approach facilitated radical cure in complex pacemaker lead infection scenarios.

Conclusions:

• Transvenous laser-assisted extraction is effective but carries risks of vascular complications.
• Bovine pericardium serves as a viable material for reconstructing large veins during lead extraction.
• A hybrid strategy integrating transvenous laser extraction with surgical repair is crucial for complex pacemaker lead infections.