SPC365

Lead extractions in a single center: a rectrospective analysis over the last 26 years

Session: Prémio Manuel Machado Macedo em Cirurgia Cardíaca
Speaker: Maria Resende

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.11 Cardiovascular Surgery - Other
Session Type: Prémios, Registos e Sessões Especiais
FP Number: ---
Authors: Maria Resende; Márcio Madeira; João Carmo; João Aquino; Inês Alves; Paulo Oliveira; Tiago Nolasco; Marta Marques; Pedro Adragão; Miguel Abecasis; José Pedro Neves; Miguel Sousa-Uva

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#1e1e1e">Introduction:</span></span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">The number of cardiovascular implantable electronic devices has increased over recent years.</span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">As a result, more of them will require removal over time.Clinical research is essential for understanding efficacy and risks of lead extractions,predictors of procedural failure and other major complications.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#1e1e1e">Objectives:</span></span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121">Analyze lead extractions performed in our medical and surgical center from 1997 to 2022</span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> and comparison between two periods&nbsp;(first and last 13 years).</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#1e1e1e">Methods:</span></span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121"> Lead explants with&lt;1 year were excluded.Definitions as in 2018 EHRA expert consensus described in table 1.</span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">The primary composite endpoint represents is defined by major procedure-related complications. Secondary endpoints included procedural and clinical success,incomplete removal,and re-infection.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#1e1e1e">Results:</span></span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121">The population included 270 patients (448 leads); </span>[mean age 68(8&ndash;92) years; 77% men]. In the first period the complete procedural success rate was 88%,clinical success rate 95% and procedural failure rate 5%. In the second period the complete procedural success rate was 84%, clinical success rate was 92% and the procedural failure rate was 8<span style="color:black">%.The p</span>rimary composite endpoint rate was 12% including a mortality of 2%.<span style="color:black">The incomplete removal rate was 16%, radiological failure of 8%. </span>On univariate analysis, regarding the second period the independent predictor of primary composite endpoint was leads with a dwell time&gt;10 years (OR 2,77, 95% CI 1,07-7,14, p=0,035). <span style="color:black">Predictors of procedure-related death</span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">: incomplete removal (OR 17,64, 95%CI 1,76-176,39, p= 0,015); radiological failure (OR 43,90, 95%CI 4,21-457,72, p=0,002); COPD (OR 10,78, 95%CI 1,40-82,53, p=0,022) and re-infection (OR 20,50, 95%.5-164,82, p=0,005).LASER sheaths were independent predictors of incomplete removal (OR 3,08, 95%CI 1,77-8,07, p=0,022).Radiological failure and incomplete removal were also predictors of re-infection (OR 6,03, 95%CI 1,36-26,64, p=0,018) and (OR 6,21, 95%CI 1,66-23,16, p=0,006) respectively.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#1e1e1e">Conclusions:</span></span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121">Incomplete lead removal and radiological failure were predictors of procedure-related death and re-infection.LASER sheaths were associated with a higher rate of incomplete removal .</span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212121">Leads with a dwell time&gt;10 years were found significant predictors of the primary composite endpoint. Surgical extractions were not associated with worst outcomes.</span></span></span></span></span></span></p>