Analysis of a 10-year period of lead removal in a referral centre. (28th May 2020)

• Record Type: Journal Article
• Authors: Marinheiro, Rita; Neves, José Pedro; Morgado, Francisco; Madeira, Márcio; Magro, Pedro; Carmo, Pedro; Adragão, Pedro
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 31:Number 2(2020)
• Page Start: 166
• Page End: 173
• Publication Date: 2020-05-28
• Subjects: Lead extraction -- Transvenous -- Open-heart surgery -- Cardiac implantable electronic devices; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivaa078
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Our goal was to analyse all lead extraction procedures (transvenous or open surgery) performed in our centre and the short- and long-term follow-up data from these patients. METHODS: All lead extractions performed from 2008 to 2017 were retrospectively reviewed for patient characteristics and indications for device implantation; indications for lead extraction; techniques used; peri- and postprocedural complications and short- and long-term follow-up data. RESULTS: A total of 159 patients (282 leads) were included [age 70 (62–78) years; 72% men]. The median follow-up time was 57 (25–90) months. Patients with lead explants were excluded. The most common indication for lead removal was infection (77%). A surgical approach was necessary in 14 patients (9%) owing to unsuccessful transvenous removal ( n = 3), large vegetation in the lead ( n = 4), concomitant valvular endocarditis ( n = 2), other indications for open surgery ( n = 4) and complicated transvenous removal ( n = 1). Removal was tried for 282 leads. Of those, 256 were completely removed. Clinical success was achieved in 155 individual patients (98%). Complications occurred in 6 patients: 3 persistent infections, 1 stroke and 2 blood vessel ruptures. The procedure-related mortality rate was 2% ( n = 3). CONCLUSIONS: Lead removal was associated with a high success rate and low all-cause complication and mortality rates. Emergency surgery because of acute complications was rare, and open-heart surgery was most frequently elective and not associated with a worse outcome.