Efficacy and safety of transvenous lead extraction using a liberal combined superior and femoral approach
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Efficacy and safety of transvenous lead extraction using a liberal combined superior and femoral approach Sing-Chien Yap 1 & Rohit E. Bhagwandien 1 & Dominic A. M. J. Theuns 1 & Yunus Emre Yasar 1 & John de Heide 1 & Mark G. Hoogendijk 1 & Charles Kik 2 & Tamas Szili-Torok 1 Received: 14 August 2020 / Accepted: 28 September 2020 # The Author(s) 2020
Abstract Purpose During transvenous lead extraction (TLE), the femoral snare has mainly been used as a bail-out procedure. The purpose of the present study is to evaluate the efficacy and safety of a TLE approach with a low threshold to use a combined superior and femoral approach. Methods This is a single-center observational study including all TLE procedures between 2012 till 2019. Results A total of 264 procedures (median age 63 (51–71) years, 67.0% male) were performed in the study period. The main indications for TLE were lead malfunction (67.0%), isolated pocket infection (17.0%) and systemic infection (11.7%). The median dwelling time of the oldest targeted lead was 6.8 (4.0–9.7) years. The techniques used to perform the procedure were the use of a femoral snare only (30%), combined rotational powered sheath and femoral snare (25%), manual traction only (20%), rotational powered sheath only (17%) and locking stylet only (8%). The complete and clinical procedural success rate was 90.2% and 97.7%, respectively, and complete lead removal rate was 94.1% of all targeted leads. The major and minor procedure-related complication rates were 1.1% and 10.2%, respectively. There was one case (0.4%) of emergent sternotomy for management of cardiac avulsion. Furthermore, there were 5 in-hospital non-procedure-related deaths (1.9%), of whom 4 were related to septic shock due to a Staphylococcus aureus endocarditis after an uncomplicated TLE with complete removal of all leads. Conclusion An effective and safe TLE procedure can be achieved by using the synergy between a superior and femoral approach. Keywords Implantable cardioverter defibrillator . Infection . Lead failure . Mechanical sheath . Pacemaker . Snare tool . Transvenous lead extraction
1 Introduction Transvenous lead extraction (TLE) is a technically complex procedure for the removal of indwelling leads and may be associated with serious complications including venous or cardiac perforation requiring emergency surgery. Cardiac implantable electronic device (CIED)-related infections and lead failures are important reasons for TLE. Despite the complexity of the procedure, TLE can be performed successfully using several approaches and tools, including simple manual * Sing-Chien Yap [email protected] 1
Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
2
Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
traction, locking stylets, telescopic sheaths, femoral snares, mechanical powered sheaths and laser sheaths [1–4]. Previous studies have shown that adding femoral snar
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