Hybrid transvenous lead extraction during cardiac surgery for valvular endocarditis
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Hybrid transvenous lead extraction during cardiac surgery for valvular endocarditis. / Yildirim, Yalin; Petersen, Johannes; Tönnis, Tobias; Reichenspurner, Hermann; Pecha, Simon.
In: J CARDIOVASC ELECTR, Vol. 31, No. 8, 08.2020, p. 2101-2106.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Hybrid transvenous lead extraction during cardiac surgery for valvular endocarditis
AU - Yildirim, Yalin
AU - Petersen, Johannes
AU - Tönnis, Tobias
AU - Reichenspurner, Hermann
AU - Pecha, Simon
N1 - © 2020 Wiley Periodicals LLC.
PY - 2020/8
Y1 - 2020/8
N2 - INTRODUCTION: In patients with endocarditis and cardiac implantable electronic devices (CIED), lead extraction is recommended according to current guidelines. In patients with short lead implant duration, lead extraction by manual traction might be sufficient for intraoperative lead removal. However, in patients with long implant duration, specialized extraction tools like laser or mechanical rotational sheaths are necessary. We report our experience with transvenous lead extraction during concomitant cardiac surgery for valvular endocarditis using mechanical rotational sheaths.METHODS AND RESULTS: Between December 2018 and April 2020, 12 patients were treated with transvenous lead extraction during open-heart surgery using mechanical rotational sheaths. Cardiac surgery was performed due to mitral, aortic, or tricuspid valve endocarditis. All patient-related and procedural data were collected, and in-hospital outcome was analyzed retrospectively. Mean patients' age was 65.2 ± 16.4 years, and 75.0% were male. Nine atrial, 15 ventricular, and 2 coronary sinus leads had to be extracted. The mean time from initial lead implantation was 94.3 ± 39.7 months. Complete procedural success was achieved in all patients with no major but one minor complication (pocket hematoma) occurring during lead extraction. Four patients with pacemaker dependency received epicardial leads, seven patients were treated in a two-step approach with endocardial leads, whereas one patient had no further CIED indication. No procedure-related mortality was seen. In-hospital survival was 91.7%.CONCLUSIONS: Valvular endocarditis surgery in combination with lead extraction using mechanical rotational sheaths is safe and feasible. It results in a high procedural success rate with prompt infection control by immediate removal of all infected lead materials.
AB - INTRODUCTION: In patients with endocarditis and cardiac implantable electronic devices (CIED), lead extraction is recommended according to current guidelines. In patients with short lead implant duration, lead extraction by manual traction might be sufficient for intraoperative lead removal. However, in patients with long implant duration, specialized extraction tools like laser or mechanical rotational sheaths are necessary. We report our experience with transvenous lead extraction during concomitant cardiac surgery for valvular endocarditis using mechanical rotational sheaths.METHODS AND RESULTS: Between December 2018 and April 2020, 12 patients were treated with transvenous lead extraction during open-heart surgery using mechanical rotational sheaths. Cardiac surgery was performed due to mitral, aortic, or tricuspid valve endocarditis. All patient-related and procedural data were collected, and in-hospital outcome was analyzed retrospectively. Mean patients' age was 65.2 ± 16.4 years, and 75.0% were male. Nine atrial, 15 ventricular, and 2 coronary sinus leads had to be extracted. The mean time from initial lead implantation was 94.3 ± 39.7 months. Complete procedural success was achieved in all patients with no major but one minor complication (pocket hematoma) occurring during lead extraction. Four patients with pacemaker dependency received epicardial leads, seven patients were treated in a two-step approach with endocardial leads, whereas one patient had no further CIED indication. No procedure-related mortality was seen. In-hospital survival was 91.7%.CONCLUSIONS: Valvular endocarditis surgery in combination with lead extraction using mechanical rotational sheaths is safe and feasible. It results in a high procedural success rate with prompt infection control by immediate removal of all infected lead materials.
KW - Cardiac Surgical Procedures
KW - Defibrillators, Implantable/adverse effects
KW - Device Removal
KW - Endocarditis/diagnostic imaging
KW - Humans
KW - Male
KW - Pacemaker, Artificial/adverse effects
KW - Retrospective Studies
KW - Treatment Outcome
U2 - 10.1111/jce.14595
DO - 10.1111/jce.14595
M3 - SCORING: Journal article
C2 - 32478463
VL - 31
SP - 2101
EP - 2106
JO - J CARDIOVASC ELECTR
JF - J CARDIOVASC ELECTR
SN - 1045-3873
IS - 8
ER -
