Analysis of a 10-year period of lead removal in a referral centre

• Published in: Interactive cardiovascular and thoracic surgery Vol. 31; no. 2; pp. 166 - 173
• Main Authors: Marinheiro, Rita, Neves, José Pedro, Morgado, Francisco, Madeira, Márcio, Magro, Pedro, Carmo, Pedro, Adragão, Pedro
• Format: Journal Article
• Language: English
• Published: England 01.08.2020
• Subjects: Aged; Arrhythmias, Cardiac - therapy; Defibrillators, Implantable - adverse effects; Device Removal - methods; Endocarditis - etiology; Endocarditis - surgery; Equipment Failure; Female; Follow-Up Studies; Forecasting; Humans; Male; Middle Aged; Pacemaker, Artificial - adverse effects; Referral and Consultation; Retrospective Studies; Lead extraction; Open-heart surgery; Cardiac implantable electronic devices; Transvenous
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivaa078

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. 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. 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). 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.