High-Risk Lead Removal by Planned Sequential Transvenous Laser Extraction and Minimally Invasive Right Thoracotomy

Autor:	Jeffrey Rottman, Stephen K. Ball, Steven J. Hoff, Christopher R. Ellis, Rashid Ahmad, Sandeep K. Goyal, S. Patrick Whalen
Rok vydání:	2014
Předmět:	medicine.medical_specialty business.industry medicine.medical_treatment Extraction (chemistry) Implantable cardioverter-defibrillator medicine.disease Pulmonary embolism Surgery Median sternotomy Physiology (medical) medicine Implant Thoracotomy Cardiology and Cardiovascular Medicine Complication Lead (electronics) business
Zdroj:	Journal of Cardiovascular Electrophysiology. 25:617-621
ISSN:	1045-3873
DOI:	10.1111/jce.12368
Popis:	Hybrid Lead Extraction for High-Risk Leads Introduction Transvenous pacemaker or implantable cardioverter defibrillator (ICD) lead extraction via mechanical or excimer laser sheath is typically safe and effective. Longer duration from implant, presence of large vegetations or thrombi, fractured leads, and prior failed extraction are risk factors predicting higher complication rates or incomplete or failed lead removal. Techniques developed for minimally invasive valve surgery were used in conjunction with laser extraction to refine a “hybrid” technique for lead extraction. We assessed the outcomes of high-risk lead extraction using this hybrid lead extraction technique. Methods and Results Retrospective assessment of clinical parameters and procedural outcomes in patients undergoing planned hybrid lead extraction from February 2008 to September 2012 was performed. We report 8 cases of hybrid lead extraction performed at our institution. We extracted 21 leads with average lead age of 13.8 years since implant. All leads were removed with complete clinical and radiographic success. There were no intraprocedure complications. One patient died of continued sepsis and 1 other had symptoms consistent with pulmonary embolism. Conclusions Hybrid lead extraction using this technique is a safe and effective approach for removal of high-risk chronic pacemaker or ICD leads. This method extends the range of approachable leads resulting in complete removal without median sternotomy. Hybrid lead extraction can be scheduled electively facilitating complete lead removal with a low complication rate and short postoperative recovery time, mitigating the risks inherent in midline sternotomy or emergent cardiac surgical rescue.
Databáze:	OpenAIRE
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