Modern approaches to transvenous lead extraction

• Published in: Rossiĭskiĭ kardiologicheskiĭ zhurnal Vol. 25; no. 7; p. 4012
• Main Authors: Podolyak, D. G., Kiprensky, A. Yu, Mironovich, S. A.
• Format: Journal Article
• Language: English; Russian
• Published: FIRMA «SILICEA» LLC 15.08.2020
• Subjects: endocardial lead; implantable electronic device; pocket infection; transvenous lead extraction
• ISSN: 1560-4071; 2618-7620
• DOI: 10.15829/1560-4071-2020-4012

Aim. To show the effectiveness and safety of modern transvenous lead extraction (TLE) techniques used in cardiac surgery.Material and methods. The study included 102 patients (men — 66, women — 36; mean age 58,3±1,7 years). Fifteen (14,7%) patients had infectious indications for TLE, 87 (85,3%) patients — non-infectious. Among the infectious indications (14,7%) were: isolated pocket infection of implantable electronic device (IED) — 13 (12,9%); pocket infection with bacteremia — 1 (0,9%); infectious endocarditis without pocket infection — 1 (0,9%). Of the non-infectious indications, 87 patients (85,3%) had: venous occlusion — 4 (3,9%); chronic pain at IED area — 10 (9,8%); device upgrade — 16 (15,7%); non-functioning (dysfunction, fracture) leads — 57 (55,9%).Results. Using simple traction, 75 (50,4%) leads were removed. TLE technique was used in 56 (37,5%) extractions. Of these, telescoping/rotational mechanical dilators were used in 23 (15,4%) and 33 (22,1%) lead extractions, respectively. In 15 (14,7%) patients with infectious indications, 33 (22,1% of total) leads were removed. In 87 (85,3%) patients with noninfectious indications, 98 (65,8% of total) leads were removed. It was not possible to completely remove 18 (12% of total) leads.Conclusion. Currently, modern TLE techniques have shown their high efficiency and safety. It is confirmed by large international studies such as ELECTRa, LExiCon, PLEXES, where success rate reaches 97,7% and mortality does not exceed 0,5%.The successful application of modern techniques enlarged the list of indications and has been widely used in routine cardiac surgery.