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Transvenous lead extraction in children with bidirectional rotational dissection sheaths
Roland Heck1,2, Björn Peters2,3, Pia Lanmüller1,2
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
Insights
Transvenous lead extraction (TLE) using powered mechanical dissection sheaths is safe and effective in children. This procedure is a vital part of lifelong device management for pediatric patients, offering high clinical success rates.
Area of Science:
- Pediatric Cardiology
- Medical Device Technology
- Interventional Cardiology
Background:
- Limited longevity of endovascular leads necessitates lifelong lead management strategies in children.
- Conservation of access vessel patency is crucial for pediatric patients requiring device leads.
- There is a need for more data on transvenous lead extraction (TLE) in pediatric populations, especially concerning advanced tools.
Purpose of the Study:
- To evaluate the feasibility, safety, and efficacy of TLE in children using powered mechanical dissection sheaths.
- To assess procedural complexity, success rates, and complications associated with TLE in pediatric patients.
- To analyze the impact of lead type on TLE outcomes in children.
Main Methods:
- Retrospective cohort study of pediatric patients (<18 years) undergoing TLE between 2015 and 2022.
- Analysis included procedural complexity, results, and complications based on consensus guidelines.
- Utilized powered bidirectional rotational dissection sheaths in a subset of complex extractions.
Main Results:
- Twenty-eight children underwent TLE, with 41 leads extracted (median dwell time 85 months).
- Complex extractions (76%) often required advanced tools, including powered dissection sheaths.
- No major complications were observed; complete procedural success was 64% and clinical success was 96%.
Conclusions:
- Transvenous lead extraction with powered mechanical dissection sheaths is feasible and safe in pediatric patients.
- TLE is a key component of lifelong lead management in children due to rare complications and high clinical success.
- Extraction success and complexity vary by lead type, with certain leads posing greater challenges.
Objectives:
Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and the use of powered mechanical dissection sheaths is limited.
Methods:
We performed a retrospective cohort study analyzing all children <18 years that underwent TLE in our institution from 2015 to 2022. Procedural complexity, results and complications were defined as recommended by recent consensus statements.
Results:
Twenty-eight children [median age 12.8 (interquartile range 11.3-14.6) years] were included. Forty-one leads were extracted [median dwell time 85 (interquartile range 52-102) months]. Extractions of 31 leads (76%) in 22 patients (79%) were complex, requiring advanced extraction tools including powered bidirectional rotational dissection sheaths in 14 children. There were no major complications. Complete procedural success was achieved in 18 (64%) and clinical success in 27 patients (96%), respectively. Procedural success and complexity varied between lead types. The Medtronic SelectSecure™ lead was associated with increased odds of extraction by simple traction (p = 0.006) and complete procedural success (p < 0.001) while the Boston Scientific Fineline™ II lead family had increased odds of partial procedural failure (p = 0.017).
Conclusions:
TLE with the use of mechanical powered rotational dissection sheaths is feasible and safe in pediatric patients. In light of rare complications and excellent overall clinical success, TLE should be considered an important cornerstone in lifetime lead management in children. Particular lead types might be more challenging and less successful to extract.
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