Related Experiment Video
Updated: Jun 26, 2026
06:04
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Transvenous Lead Extraction Using Mechanical Rotational Dilator Sheaths: A 19-Year Single-Center Experience from a
Hayrettin Hakan Aykan1,2, Musa Öztürk1, Yasemin Nuran Dönmez3
1Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara 06100, Türkiye.
Journal of Cardiovascular Development and Disease
|June 25, 2026
Summary
Transvenous lead extraction (TLE) using mechanical rotational dilator sheaths is feasible in pediatric patients, with acceptable success rates. However, major complications, especially with implantable cardioverter-defibrillator (ICD) leads, necessitate experienced centers and surgical backup.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Medical Device Technology
Background:
- Increasing use of cardiac implantable electronic devices (CIEDs) in pediatric and adolescent populations necessitates transvenous lead extraction (TLE).
- Limited data exist on the long-term outcomes and safety of TLE in this young demographic.
- Mechanical rotational dilator sheaths are increasingly used for TLE, but their efficacy in pediatric patients requires further evaluation.
Purpose of the Study:
- To evaluate the efficacy and safety of transvenous lead extraction (TLE) using mechanical rotational dilator sheaths in a pediatric cohort.
- To compare outcomes between two specific sheath systems: Evolution® and TightRail™.
- To identify risk factors associated with complications during TLE in pediatric patients.
Main Methods:
- Retrospective single-center study of 35 pediatric patients (mean age 15.1 years) undergoing TLE between 2007 and 2025.
- Extraction of 40 leads using either Evolution® or TightRail™ mechanical rotational dilator sheath systems.
- Comparison of procedural success rates (complete and clinical) and complication incidence between sheath groups and patient subgroups.
Main Results:
- Complete procedural success was achieved in 66% of patients, and clinical success in 86%.
- Major complications occurred in 14% of patients, with all occurring in those with implantable cardioverter-defibrillator (ICD) leads (p=0.013).
- No significant difference in success rates or major complications was observed between the Evolution® and TightRail™ sheath systems.
Conclusions:
- Transvenous lead extraction using mechanical rotational dilator sheaths is a feasible procedure in pediatric patients, offering acceptable success rates.
- The risk of major complications is considerable, particularly for patients with ICD leads, highlighting the need for careful planning.
- Performing TLE in experienced centers with immediate surgical backup is crucial for managing potential complications in this population.
