Transvenous lead extraction in children with bidirectional rotational dissection sheaths.

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.