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Lead extraction using the PISA technique: Comparison of non-infected vs infected leads
Session:
Posters (Sessão 4 - Écran 1) - Dispositivos em Arritmologia
Speaker:
André Paulo Ferreira
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
André Paulo Ferreira; Bruno Tereno Valente; Pedro Silva Cunha; Guilherme Portugal; Paulo Osório; Ana Lousinha; Sérgio Laranjo; Rui Cruz Ferreira; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Background</span></strong><span style="color:black">: It has been hypothesized that the lead extraction (LE) of non-infected leads can be more challenging than that of infected ones, due to the absence of the dissolving effect of adherences provided by the infection. Unlike other LE techniques that use a locking stylet, the PISA technique (PT) instead uses a classic long stylet that allows for the possibility of stopping a procedure when the risk exceeds de benefit in case of noninfectious indications. The specificity of the PT makes it an excellent choice for lead extraction of non-infected leads.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Purpose</span></strong><span style="color:black">: To investigate the safety, success, and procedural complexity of LE of non-infected vs infected leads using the PISA technique (PT).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Methods</span></strong><span style="color:black">: A retrospective single-center study of consecutive patients undergoing LE due to lead dysfunction and/or venous occlusion (NI group) or CIED infection (I group), between February 2013 and October 2022. The PT was used in all patients. Patient-related variables, success, complications, and mortality data were assessed.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results</span></strong><span style="color:black">: A total of 76 non-infected CIED leads were extracted from 52 patients in the NI group, and a total of 379 infected CIED leads were extracted from 205 patients in the I group, during the study period. Patient mean age was 73.5±17.0 years, 72.5% were male, mean ejection fraction was 48.7±13.9%. The mean implant-to-extract duration was 67.6±51.8 months in the NI group vs 88.4±73.1 months in the I group (p=0.07). Regarding the complexity of the procedures, simple traction alone was done in 38.5% vs 28.3% (p=0.154) of the LEs, a single sheath was used in 34.6% vs 38.5% (p=0.602), and multiple sheaths were required in 26.9% vs 33.2% (p=0.388), in the NI group vs I group respectively. There were no significant differences regarding the radiographic success rate 96.2% vs 94.1% (p=0.553), and the clinical procedural success rate 96.2% vs 98.52% (p=0.307) of the attempted lead extractions in both groups. There were 3 (1.5%) major complications in the I group (comprised of 3 cardiac tamponades requiring pericardiocentesis/sternotomy), and none in the NI group (p=0.243). There were significantly fewer minor complications (comprised mostly of pocket hematomas) in the NI group 1.9% vs 9.8% (p=0.034) in the I group. No extraction-related mortality was observed. One patient (1.9%) died before hospital discharge in the NI group vs 9 patients (4.4%, p=0.384) in the I group.</span></span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Conclusion:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> Our center’s experience of lead extraction with the PISA technique indicates a similar procedural success, complexity, and safety for the extraction of both non-infected and infected CIED leads. Non-infected leads can be extracted with excellent safety keeping similar success. </span></span></span></p>
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