Transvenous lead extraction after heart transplantation: How to avoid abandoned lead fragments
Standard
Transvenous lead extraction after heart transplantation: How to avoid abandoned lead fragments. / Hahnel, Fabian; Pecha, Simon; Bernhardt, Alexander; Barten, Markus J; Chung, Da-Un; Sinning, Christoph; Willems, Stephan; Reichenspurner, Hermann; Hakmi, Samer.
In: J CARDIOVASC ELECTR, Vol. 31, No. 4, 01.04.2020, p. 854-859.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Transvenous lead extraction after heart transplantation: How to avoid abandoned lead fragments
AU - Hahnel, Fabian
AU - Pecha, Simon
AU - Bernhardt, Alexander
AU - Barten, Markus J
AU - Chung, Da-Un
AU - Sinning, Christoph
AU - Willems, Stephan
AU - Reichenspurner, Hermann
AU - Hakmi, Samer
N1 - © 2020 Wiley Periodicals, Inc.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - BACKGROUND: Many patients awaiting heart transplantation (HTX) have a cardiac implantable electronic device (CIED). Lead removal is often still a part of the HTX procedure. Abandoned lead fragments carry a risk for infections and prohibit magnetic resonance imaging (MRI) imaging. This study evaluated the concept of an elective lead management algorithm after HTX.METHODS AND RESULTS: Between 2009 and 2018, 102 consecutive patients with previously implanted CIED underwent HTX. Lead removal by manual traction during HTX was performed in 74 patients until December 2014. Afterward, treatment strategy was changed and 28 patients received elective lead extraction procedures in a hybrid operating room (OR) using specialized extraction tools. Total of 74 patients with 157 leads underwent lead extraction by manual traction during HTX. The mean lead age was 32.3 ± 38.7 months. Postoperative X-ray revealed abandoned intravascular lead fragments in 31(41.9%) patients, resulting in a complete lead extraction rate of only 58.1%. The high rate of unsuccessful lead extractions led to the change in the extraction strategy in 2015. Since then, HTX was performed in 28 CIED patients. In those patients, 64 leads with a mean lead age of 53.8 ± 42.8 months were treated in an elective lead extraction procedure. No major or minor complications occurred during lead extraction. All leads could be removed completely, resulting in a procedural success rate of 100%.CONCLUSION: Our results demonstrate that chronically implanted leads should be removed in an elective procedure, using appropriate extraction tools. This enables complete lead extraction, which reduces the infection risk in this patient population with the necessity for permanent immunosuppressive therapy and allows further MRI surveillance.
AB - BACKGROUND: Many patients awaiting heart transplantation (HTX) have a cardiac implantable electronic device (CIED). Lead removal is often still a part of the HTX procedure. Abandoned lead fragments carry a risk for infections and prohibit magnetic resonance imaging (MRI) imaging. This study evaluated the concept of an elective lead management algorithm after HTX.METHODS AND RESULTS: Between 2009 and 2018, 102 consecutive patients with previously implanted CIED underwent HTX. Lead removal by manual traction during HTX was performed in 74 patients until December 2014. Afterward, treatment strategy was changed and 28 patients received elective lead extraction procedures in a hybrid operating room (OR) using specialized extraction tools. Total of 74 patients with 157 leads underwent lead extraction by manual traction during HTX. The mean lead age was 32.3 ± 38.7 months. Postoperative X-ray revealed abandoned intravascular lead fragments in 31(41.9%) patients, resulting in a complete lead extraction rate of only 58.1%. The high rate of unsuccessful lead extractions led to the change in the extraction strategy in 2015. Since then, HTX was performed in 28 CIED patients. In those patients, 64 leads with a mean lead age of 53.8 ± 42.8 months were treated in an elective lead extraction procedure. No major or minor complications occurred during lead extraction. All leads could be removed completely, resulting in a procedural success rate of 100%.CONCLUSION: Our results demonstrate that chronically implanted leads should be removed in an elective procedure, using appropriate extraction tools. This enables complete lead extraction, which reduces the infection risk in this patient population with the necessity for permanent immunosuppressive therapy and allows further MRI surveillance.
KW - Adult
KW - Defibrillators, Implantable/adverse effects
KW - Device Removal/adverse effects
KW - Elective Surgical Procedures
KW - Female
KW - Foreign Bodies/etiology
KW - Heart Failure/surgery
KW - Heart Transplantation
KW - Humans
KW - Immunosuppressive Agents/therapeutic use
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Pacemaker, Artificial/adverse effects
KW - Prosthesis-Related Infections/etiology
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1111/jce.14393
DO - 10.1111/jce.14393
M3 - SCORING: Journal article
C2 - 32052893
VL - 31
SP - 854
EP - 859
JO - J CARDIOVASC ELECTR
JF - J CARDIOVASC ELECTR
SN - 1045-3873
IS - 4
ER -
