Procedural Characteristics and Outcomes of Transvenous Lead Extraction in Patients With Prior Sternotomy

A history of sternotomy has been debated as either a potential protective factor or a possible risk for worse outcomes in patients undergoing transvenous lead extraction (TLE). The safety and efficacy of TLE in this population remain underexplored.

This study sought to evaluate the impact of prior sternotomy on procedural outcomes in patients undergoing TLE.

Using a prospectively maintained registry, we included all patients undergoing TLE at our center between 1996 and 2022. Patients were categorized into 2 groups based on whether they had a prior sternotomy (PS). Baseline characteristics, procedural outcomes, and safety profiles were compared. Logistic regression was performed to identify independent predictors of major complications.

Among 4,846 patients undergoing TLE, 1,344 (27.7%) had a prior sternotomy. These patients had a higher prevalence of comorbidities and an infectious indication for extraction. PS patients experienced significantly lower rates of major complications (1.4% vs 3.0%, P = 0.001), (1.2% vs 2.2%, P = 0.03), and emergent rescue cardiac surgeries (0.7% vs 1.6%, P = 0.011), with higher procedural success rates. On multivariable analysis, PS was independently associated with reduced odds of major complications (OR = 0.52; 95% CI: 0.30-0.89; P = 0.016) and major cardiovascular injury (OR = 0.54; 95% CI: 0.30-0.98; P = 0.043). These findings persisted in a propensity score-matched cohort of 1,256 pairs, confirming significantly lower complication rates in the PS group.

Despite exhibiting higher comorbidities, PS patients had fewer major complications during TLE, suggesting a protective effect. Still, the challenges of repeat sternotomy highlight the need for recognizing these patients as high-risk should complications occur.