Procedural Characteristics and Outcomes of Transvenous Cardiac Device Extraction in Patients With Left Ventricular...

Durable left ventricular assist devices (LVADs) are susceptible to infection. The presence of a transvenous cardiac implantable electronic device (CIED) may further elevate this risk, making it necessary to remove the CIED system. This report presents the procedural characteristics and outcomes of CIED system extraction in patients with LVADs.

This is a single-center retrospective study that included patients with durable LVADs who underwent transvenous CIED extraction at our institution from 2017 to 2023.

Twenty patients with LVAD (HeartMate II = 14; HeartMate III = 6) underwent CIED removal during the study period. The median age was 52.5 (IQR = 42.5-56.5) years, and 7 patients had ischemic cardiomyopathy. Ninety percent (n = 18) of the extractions were due to infection, while 10% (n = 2) were for lead management. Complete removal of all leads was accomplished in 19 patients (95%). Overall, 40 out of 45 leads were removed during 20 procedures. Simple traction was used in 8 patients and specialized extraction tools were used in 12 (laser sheaths = 10; mechanical rotational sheaths = 7; both = 5). No leads were removed in one patient (5 leads; 2 abandoned leads with 42.5 years intravascular dwell time). There were no major procedure-related complications. Two minor procedure-related complications included a femoral arterial pseudoaneurysm and one pocket revision due to persistent surgical site bleeding. During a median follow-up of 17 (IQR = 8.0-22.3) months, 8 patients underwent pump exchange due to persistent infection, and 15 remained on chronic suppressive antibiotics. Nine patients died during the follow-up.

The extraction of CIED systems in patients with LVAD is safe and feasible, exhibiting low procedure-related morbidity and mortality. However, the long-term prognosis for these patients remains poor despite the removal of CIEDs.