ISMICS 2023 Annual Meeting

Zero SVC Injury With Transvenous Lead Extraction Utilizing Mechanical Right-Left Rotation System:
A Contemporary Experience

Purpose

•Transvenous pacemaker/defibrillator lead extraction (TLE) bridges the specialties of EP and cardiac surgery.

•Two main approaches: mechanical extraction or laser-powered tools which are susceptible to superior vena cava (SVC) injury.

•Debate exists regarding the safety and efficacy of these approaches and whether extraction should occur in the operating room or the EP Cath lab.

Materials and Methods

•TLE cases performed by 4 cardiac surgeons between January 2019 and December 2021.

•Performed in the operating room with TEE guidance (to assess for pericardial effusion and valve function).

•All cases performed using mechanical right-left controlled rotation system.

•Outcomes: procedural success, complications per 2017 Heart Rhythm Society guidelines, 30-day mortality.

•Procedural success = complete extraction of all leads without major complication.

Results

•210 leads extracted from 104 patients (Table 1)

•Baseline Characteristics

•Mean age 63.8±16.7 years / 69% (72/104) male

•Mean BMI 30.1±7.71 kg/m2

•Most common comorbidities: hypertension (77%), heart failure (68%) and coronary artery disease (45%)

•Mean LVEF 36.6±17.1%

•Prior sternotomy in 25% (26/104) of patients

Procedural Details:

•Indications for extraction: infection (69%) and lead malfunction (19%).

•Devices: single-chamber Defibrillators (46%) and Pacemakers (33%).

•Mean age oldest lead 9.79±7.25 years.

Outcomes:

•No SVC tears

•0.0% Procedure-related mortality.

•95% Complete procedural success (99/104) cases:

•Distal lead fracture (3), Inferior vena cava laceration requiring emergent sternotomy (1), Tricuspid valve damage requiring delayed tricuspid valve replacement (1).

•4 (3.9%) minor complications:

•3 wound hematomas and 1 superficial wound infection.

•30-day mortality of 1.9%

Conclusions

•Mechanical Right-Left controlled rotation system enables safe and effective Transvenous Lead Extraction.

•No SVC tears in our experience.

•Performance of procedure in the operating room by cardiac surgeons allows for rapid conversion to sternotomy in event of major complication.

ISMICS 2023 Annual Meeting

Zero Svc Injury With Transvenous Lead Extraction Utilizing Mechanical Right-left Rotation System: A Contemporary Experience

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