Indications and outcomes of elective open chest lead extractions
Anshul R Gupta1, John R Power2, Yang Yang2
1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Elective open lead extraction (OLE) is a safe procedure for removing cardiovascular implantable electronic device leads, especially when valve intervention is needed or transvenous extraction risks are high. Outcomes show high success and survival rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Complications from cardiovascular implantable electronic devices (CIEDs) may require lead removal.
- Open extraction is an option for high-risk patients or those needing concurrent cardiac surgery.
Purpose of the Study:
- To investigate the outcomes of elective open lead extractions (OLE) in patients at two tertiary care centers.
Main Methods:
- Retrospective chart review of 29 patients undergoing elective OLE.
- Analysis of lead characteristics, reasons for extraction, procedural outcomes, and survival rates.
Main Results:
- 69 leads extracted from 29 patients; 77% completely removed.
- Common indications included infective endocarditis (41%) and tricuspid valve intervention (38%).
- Major complications and procedural failure rates were low (3% each); 30-day and 1-year survival were 100% and 92% respectively.
Conclusions:
- Elective open lead extraction demonstrated a 97% clinical success rate.
- OLE is a viable alternative for patients requiring valvular intervention or at high risk for transvenous lead extraction.
Background:
Complications associated with cardiovascular implantable electronic devices may necessitate device and lead removal. An open approach to removal may be electively chosen in cases with high risk of complications or those requiring additional concomitant cardiac surgery. This study aimed to investigate outcomes of patients who underwent elective open lead extractions (OLE) at two large tertiary care centers.
Methods:
The records of 29 patients undergoing elective OLE were analyzed through retrospective chart review.
Results:
69 total leads were extracted from 29 patients (77% completely, 23% partially). The average age of the oldest leads was 13.3 ± 11.3 years. Infective endocarditis with severe valvular insufficiency requiring valvular intervention (41%)-an infectious etiology, and tricuspid valve intervention to correct RV lead-related severe TR (38%)-a noninfectious etiology, were the most common reasons for OLE. 38% of the patients had additional co-primary or secondary indications for open extraction, such as CABG and pericardiectomies. The rate of major complications and procedural failure was 3% each (1/29). 30-day survival was 100%, and 1-year survival was 92%. The average length of hospital stay was 15 days and higher among those undergoing OLE for infectious indications.
Conclusion:
Open lead extractions offered a similar clinical success rate (97%) to transvenous extractions in this cohort and may be a viable alternative for those necessitating valvular intervention or when the risk of complications from TLE is considered very high.
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