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. 2019 Mar 15:279:35-39.
doi: 10.1016/j.ijcard.2018.12.074. Epub 2019 Jan 3.

Cardiac surgeon and electrophysiologist shoulder-to-shoulder approach: Hybrid room, a kingdom for two. A zero mortality transvenous lead extraction single center experience

Maurizio Roberto  1 , Rita Sicuso  2 , Sabrina Manganiello  1 , Valentina Catto  3 , Luca Salvi  4 , Matteo Nafi  4 , Michela Casella  3 , Fabiana Rossi  1 , Francesco Grillo  1 , Matteo Saccocci  1 , Alessio Gasperetti  3 , Rosario Cervellione  3 , Davide Carcione  5 , Francesco Alamanni  1 , Claudio Tondo  6 , Antonio Dello Russo  3
Affiliations

Cardiac surgeon and electrophysiologist shoulder-to-shoulder approach: Hybrid room, a kingdom for two. A zero mortality transvenous lead extraction single center experience

Maurizio Roberto et al. Int J Cardiol. .

Abstract

Background: Nowadays, transvenous lead extraction (TLE) is considered an essential technique in lead management strategy. Since 2011, a multidisciplinary approach was undertaken in our centre involving electrophysiologists, cardiac surgeons and anaesthesiologists to improve cross- unit cooperation and minimize complications and mortality. The present paper reports procedural outcomes and complications of our lead extraction experience.

Methods: We retrospectively collected and analysed data from all consecutive patients undergoing cardiac implantable electronic device leads TLE at the IRCCS Centro Cardiologico Monzino between January 2011 and November 2017.

Results: One-hundred fifty patients (111 males, 68 ± 13 years) underwent extraction procedures. The most common extraction indication were infections (86.7%) and TLE was carried out by laser-based approach in 88 (58.6%) patients, by mechanical dilating sheaths in 58 (38.7%) patients and by a combined approach (TLE + open surgical intervention) in 4 (2.7%) patients. Procedural success was obtained in 146 (97.3%) cases with only 3 (2.0%) major complications with 2 cases of structural injury with tamponade requiring emergent median sternotomy. Open surgery extraction was required in 4 patients, after an attempt to TLE, due to leads strict adhesion to cardiac or vascular structures, whereas in 5 (3.3%) cases, the treatment of choice was a combined approach consisting in transvenous leads extraction followed by planned surgery.

Conclusions: TLE is a complex procedure that sometimes leads to fatal complications. In our single center experience, a multidisciplinary approach involving electrophysiologist, cardiac surgeon, anaesthesiologist in an operating room allows a safer approach and major complications treatment.

Keywords: Cardiac implantable electronic device; Lead extraction; Lead extraction technique; Lead-related complications; Multidisciplinary team.

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