The Bridge Occlusion Balloon as a safety net in a high-risk transvenous lead extraction procedure

TY - JOUR

T1 - The Bridge Occlusion Balloon as a safety net in a high-risk transvenous lead extraction procedure

AU - Pecha, Simon

AU - Vogler, Julia

AU - Reichenspurner, Hermann

AU - Hakmi, Samer

N1 - © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Injuries to the superior vena cava (SVC) during transvenous lead extraction (TLE) procedures are a rare but life-threatening complication. The Bridge Occlusion Balloon (BOB) is specifically designed for temporary SVC occlusion in TLE procedures. We report the first case of a 27-year-old man using the BOB as a safety net in a high-risk TLE procedure. This patient, with a congenitally corrected transposition of the great arteries and a third-degree atrioventricular block, presented with 4 dysfunctional pacemaker leads, venous stenosis and the necessity for a new pacemaker system. The leads were implanted for 10 and 19 years. The BOB was placed with a radiopaque marker at the cavoatrial junction and was inflated with 46 ml of an 80/20 saline/contrast agent mixture. An angiography was performed to confirm SVC occlusion. With the deflated balloon in place, the TLE procedure with laser and mechanical sheaths was performed. Successful extraction of 2 dysfunctional leads, as well as venous recanalization, for the new right atrial and right ventricular lead implantation was achieved. We have shown the feasibility of using powered extraction sheaths with a deflated BOB in place. This allows for immediate balloon inflation, in case of an SVC perforation.

AB - Injuries to the superior vena cava (SVC) during transvenous lead extraction (TLE) procedures are a rare but life-threatening complication. The Bridge Occlusion Balloon (BOB) is specifically designed for temporary SVC occlusion in TLE procedures. We report the first case of a 27-year-old man using the BOB as a safety net in a high-risk TLE procedure. This patient, with a congenitally corrected transposition of the great arteries and a third-degree atrioventricular block, presented with 4 dysfunctional pacemaker leads, venous stenosis and the necessity for a new pacemaker system. The leads were implanted for 10 and 19 years. The BOB was placed with a radiopaque marker at the cavoatrial junction and was inflated with 46 ml of an 80/20 saline/contrast agent mixture. An angiography was performed to confirm SVC occlusion. With the deflated balloon in place, the TLE procedure with laser and mechanical sheaths was performed. Successful extraction of 2 dysfunctional leads, as well as venous recanalization, for the new right atrial and right ventricular lead implantation was achieved. We have shown the feasibility of using powered extraction sheaths with a deflated BOB in place. This allows for immediate balloon inflation, in case of an SVC perforation.

KW - Adult

KW - Atrioventricular Block/etiology

KW - Balloon Occlusion/methods

KW - Cardiac Surgical Procedures

KW - Device Removal/methods

KW - Humans

KW - Male

KW - Pacemaker, Artificial/adverse effects

KW - Radiography, Thoracic

KW - Transposition of Great Vessels/complications

KW - Vena Cava, Superior

U2 - 10.1093/icvts/ivx296

DO - 10.1093/icvts/ivx296

M3 - SCORING: Journal article

C2 - 29049802

VL - 26

SP - 360

EP - 361

JO - INTERACT CARDIOV TH

JF - INTERACT CARDIOV TH

SN - 1569-9293

IS - 2

ER -