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Transvenous removal of pacing and ICD leads: single referral center experience.
Sub-topic : Device Complications and Lead Extraction
Session type : Moderated Posters
Authors : MG Bongiorni (Pisa,IT), E Soldati (Pisa,IT), L Segreti (Pisa,IT), G Zucchelli (Pisa,IT), A Di Cori (Pisa,IT), S Viani (Pisa,IT), L Paperini (Pisa,IT), D Levorato (Pisa,IT), G Branchitta (Pisa,IT), D Andreini (Pisa,IT)
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A. Di Cori1
1University Hospital of Pisa, Cardiology Operative Unit 2 - Pisa - Italy
Topic(s): Device complications and lead extraction
Introduction: Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center.
Methods: Since January 1997 to December 2014, we managed 2250 consecutive patients (1718 men, mean age 65.3 years) with 4114 leads (mean pacing period 71.8 months, range 1–576). PL were 3328 (1582 ventricular, 1391 atrial, 355 coronary sinus leads), DL were 786 (765 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 83% (systemic 28%, local 55%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique (Cook Vascular, USA) and if necessary, other intravascular tools (Catchers and Lassos, Osypka, Grentzig-Whylen, G); an Approach through the Internal Jugular Vein (JA) was performed in case of free-floating leads or failure of the standard approach.
Results: Removal was attempted in 4105 leads because the technique was not applicable in 9 PL. Among these, 4019 leads were completely removed (97.9%), 44 (1.1%) partially removed, 42 (1.0%) not removed. Among 4020 exposed leads, 625 were removed by manual traction (15.5%), 2998 by mechanical dilatation using the venous entry site (74.6%), 32 by femoral approach (FA) (0.8%) and 279 by JA (7.0%). All the free-floating leads were completely removed, 25.8% by FA and 74.2% by JA. Major complications occurred in 13 cases (0.6%): cardiac tamponade (12 cases, 2 deaths), hemotorax (1 death).
Conclusions: Our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads.