Safety and Clinical Outcomes of Transvenous Lead Extraction for Cardiac Device Infections in the Very Elderly

The increasing use of cardiac implantable electronic devices (CIEDs) has led to a rise in transvenous lead extractions (TLE), particularly for device-related infections. The elderly represent a growing subgroup undergoing TLE, but data on their outcomes are limited.

To evaluate the safety and in-hospital outcomes of TLE in patients aged ≥ 80 years with device-related infections.

We analyzed the National Inpatient Sample (NIS) from 2016 to 2020 to identify hospitalizations involving TLE for device-related infections. Patients were stratified by age: < 80 years and ≥ 80 years. The primary outcome was in-hospital mortality. Secondary outcomes included major procedural complications and length of stay. Multivariate logistic regression identified independent predictors of in-hospital mortality and complications.

Among 30 670 patients who underwent TLE, 6530 (21.3%) were aged ≥ 80 years. In-hospital mortality did not differ significantly between groups (4.0% vs. 4.6%, p = 0.40), nor did overall complication rates (6.7% vs. 6.9%, p = 0.81). However, elderly patients had higher rates of post-procedural stroke (0.3% vs. 0.02%, p = 0.002) and bleeding (1.6% vs. 0.8%, p = 0.04). Independent predictors of mortality included chronic kidney disease (aOR 2.2, 95% CI: 1.2-4.2), cirrhosis (aOR 12.2, 95% CI: 1.1-133), and respiratory failure (aOR 50.7, 95% CI: 6-425). Elderly patients were more frequently discharged to rehabilitation facilities (40.3% vs. 25.5%, p < 0.001).

Elderly patients undergoing TLE for infections had similar in-hospital mortality and complication rates compared to younger patients. Age alone should not preclude TLE. However, increased risks of stroke and bleeding warrant targeted perioperative assessment. Further studies are needed to assess long-term outcomes in this population.