eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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3/2022
vol. 19
 
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abstract:
Original paper

The role of cardiac surgery in transvenous lead extraction. A high-volume center experience with 3207 procedures

Łukasz Tułecki
1
,
Marek Czajkowski
2
,
Sylwia Targońska
2
,
Konrad Tomków
1
,
Dorota Nowosielecka
3
,
Wojciech Jacheć
4
,
Anna Polewczyk
5
,
Andrzej Kutarski
6

  1. Department of Cardiac Surgery, The Pope John Paul II Province Hospital, Zamosc, Poland
  2. Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
  3. Department of Cardiology, The Pope John Paul II Province Hospital, Zamosc, Poland
  4. 2nd Department of Cardiology, Silesian Medical University, Zabrze, Poland
  5. Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
  6. Department of Cardiology, Medical University of Lublin, Lublin, Poland
Kardiochirurgia i Torakochirurgia Polska 2022; 19 (3): 122-129
DOI: https://doi.org/10.5114/kitp.2022.119759
Online publish date: 2022/10/08
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Introduction
The guidelines stress the importance of cardiac surgery in the management of life-threatening complications arising from lead removal. Aim: To delineate the roles of the cardiac surgeon during transvenous lead extraction (TLE).

Material and methods
3207 patients (38.7% F), average age 65.7 years, underwent the extraction of PM/ICD leads using standard non-powered mechanical systems within the last 14 years.

Results
Procedural success 96.1%, clinical success 97.8%, procedure-related death 0.18%, major complications 1.9% (cardiac tamponade 1.2%, hemothorax 0.2%, tricuspid valve damage 0.3%, stroke and pulmonary embolism < 1%). The roles for cardiac surgery in TLE have been categorized into five areas: 1. Emergency cardiac surgery (1.18% of all patients), 2. Late surgical intervention (TLE-related tricuspid valve dysfunction) (0.44%), 3. Cardiac surgery complementing partially successful TLE (0.68%: removal of lead fragments), 4. Epicardial pacemaker implantation through sternotomy for the above-mentioned reasons (0.65%), 5. Delayed surgical intervention after TLE to place epicardial LV leads (0.53%). Additionally, surgical experience can help in prevention and treatment of wound infection after TLE.

Conclusions
Emergency cardiac surgery (mainly due to severe bleeding) is still the most frequent reason for intervention (33.63% (38/113) of all surgical procedures). The other areas of surgical interventions in lead management are: cardiac surgery complementing partially successful TLE, repair or replacement of the malfunctioning tricuspid valve secondary to lead extraction and implantation of permanent epicardial pacing leads after sternotomy or epicardial left ventricle lead to optimize cardiac resynchronization. Experience of a single high-volume lead extraction center confirms the need for close collaboration between the cardiologist and the cardiac surgeon, whose role goes far beyond mere surgical standby.

keywords:

transvenous lead extraction, extraction complications, surgical management of cardiac tamponade during extraction procedure, epicardial pacing
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