Procedural Characteristics and Outcomes of Transvenous Lead Extraction in Patients With Prior Sternotomy
Mohamad Mdaihly1, Joe Demian1, Arwa Younis1
1Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
JACC. Clinical Electrophysiology
|March 6, 2026
Summary
Patients with prior sternotomy (PS) undergoing transvenous lead extraction (TLE) experienced fewer complications, suggesting a protective effect. However, potential challenges necessitate careful risk assessment for these patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Extraction
Background:
- The impact of prior sternotomy on transvenous lead extraction (TLE) outcomes is debated.
- Prior sternotomy's role as a protective factor or risk in TLE is underexplored.
Purpose of the Study:
- To evaluate the impact of prior sternotomy on procedural outcomes in patients undergoing TLE.
- To compare safety and efficacy of TLE in patients with and without prior sternotomy.
Main Methods:
- Analysis of a prospectively maintained registry of TLE procedures (1996-2022).
- Categorization of patients into prior sternotomy (PS) and no prior sternotomy groups.
- Comparison of baseline characteristics, procedural outcomes, and safety profiles using logistic regression and propensity score matching.
Main Results:
- Patients with prior sternotomy (PS) had higher comorbidities and infectious indications for extraction.
- PS patients showed significantly lower rates of major complications (1.4% vs 3.0%), major cardiovascular injury (1.2% vs 2.2%), and emergent rescue cardiac surgeries (0.7% vs 1.6%).
- Prior sternotomy was independently associated with reduced odds of major complications (OR=0.52) and major cardiovascular injury (OR=0.54) in multivariable analysis.
Conclusions:
- Prior sternotomy may have a protective effect during transvenous lead extraction, despite increased comorbidities.
- Recognizing potential challenges associated with repeat sternotomy is crucial for risk stratification.
- Further research into the specific mechanisms underlying this protective effect is warranted.
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