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Lead removal, a safe procedure in a referral center
Session:
Sessão de Comunicações Orais - Dispositivos Médicos
Speaker:
Rita Marinheiro
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.5 Device Complications and Lead Extraction
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Marinheiro; José Pedro Neves; Francisco Bello Morgado; Márcio Madeira; Pedro Magro; Pedro Lopes Do Carmo; Diogo Cavaco; Francisco Moscoso Costa; João Carmo; Ana Braga; Miguel Abecassis; Marta Marques; Sérgio Boshoff; Jose Calquinha; Pedro Adragão
Abstract
<p> </p> <p><strong>INTRODUCTION: </strong>The number of lead removal of cardiac implantable electronic devices (CIED) has increased in recent years as a consequence of a larger number of implantations and aging of this population. Although once considered a “dark face” of CIED, it has evolved in the last decades with many improvements in materials and techniques used.</p> <p><strong>OBJECTIVES: </strong>Analyze all lead extraction procedures (transvenous or open surgery) performed in a single center and short- and long-term outcomes.</p> <p><strong>METHODS: </strong>All lead extractions performed between 2008 and 2017 were retrospectively reviewed. Patients´ characteristics and indication for device implantation; indications for lead extraction; techniques used and personnel; complications peri- and post-procedural and short and long-term follow-up were evaluated. </p> <p><strong>RESULTS: </strong>A total of 189 patients (330 leads) were included (mean 69 ± 14 years, 73% male). Patients´ characteristics are presented in panel A. Lead explant was performed in 30 patients (16%) and lead extraction in 159 (84%). The most common indication for lead removal was infection (73%) (panel B). Cardiac surgeons were responsible for 75% of the procedures. Techniques used are presented in panel C. Surgical approach was necessary in 14 patients (7%) due to unsuccessful transvenous removal (n=3), large vegetation in the lead (n=4), concomitant valvular endocarditis (n=2), other indication for open surgery (n=4) and complicated transvenous removal (n=1). Removal was tried in 330 leads. Of those, 298 were completely removed, 14 were partially removed and 18 were not removed (>4cm of remnant material). On an individual patient basis, clinical success was achieved in 185 patients (97%). Complications occurred in 6 patients: 3 persistent infections, 1 stroke, 2 vessel rupture. Related-procedural mortality was 1.5% (n=3). The median follow-up was 54 (IQR 20-87) months. Long-term survival was worse in patients with infection (logrank p=0.01) (panel D1) even after adjustment for other baseline characteristics, but it was not statistically different between patients who performed transvenous approach and open heart surgery (logrank p=0.62) (panel D2).</p> <p><strong>CONCLUSION: </strong>Lead removal was associated with a high success rate with low all cause complication and mortality rates. Emergent surgery due to acute complications was very rare and open heart surgery was mostly elective and not associated with a worse outcome.</p>
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