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. 2022 Sep 27;19(19):12279.
doi: 10.3390/ijerph191912279.

Tricuspid Valve Damage Related to Transvenous Lead Extraction

Anna Polewczyk  1   2 , Wojciech Jacheć  3 , Dorota Nowosielecka  4 , Andrzej Tomaszewski  5 , Wojciech Brzozowski  5 , Dorota Szczęśniak-Stańczyk  5 , Krzysztof Duda  6 , Andrzej Kutarski  5
Affiliations

Tricuspid Valve Damage Related to Transvenous Lead Extraction

Anna Polewczyk et al. Int J Environ Res Public Health. .

Abstract

Background: Damage to the tricuspid valve (TVD) is now considered either a major or minor complication of the transvenous lead extraction procedure (TLE). As yet, the risk factors and long-term survival after TLE in patients with TVD have not been analyzed in detail.

Methods: This post hoc analysis used clinical data of 2631 patients (mean age 66.86 years, 39.64% females) who underwent TLE procedures performed in three high-volume centers. The risk factors and long-term survival of patients with worsening tricuspid valve (TV) function after TLE were analyzed.

Results: In most procedures (90.31%), TLE had no negative influence on TV function, but in 9.69% of patients, a worsening of tricuspid regurgitation (TR) to varying degrees was noted, including significant dysfunction in 2.54% of patients. Risk factors of TLE relating to severe TVD were: TLE of pacing leads (5.264; p = 0.029), dwell time of the oldest extracted lead (OR = 1.076; p = 0.032), strong connective scar tissue connecting a lead with tricuspid apparatus (OR = 5.720; p < 0.001), and strong connective scar tissue connecting a lead with the right ventricle wall (OR = 8.312; p < 0.001). Long-term survival (1650 ± 1201 [1-5519] days) of patients with severe TR was comparable to patients without tricuspid damage related to TLE.

Conclusions: Severe tricuspid valve damage related to TLE is relatively rare (2.5%). The main risk factors for the worsening of TV function are associated with a longer lead dwell time (more often the pacing lead), causing stronger connective tissue scars connecting the lead to the tricuspid apparatus and right ventricle. TVD is unlikely to affect long-term survival after TLE.

Keywords: long-term survival; risk factors; transvenous lead extraction complications; tricuspid valve damage.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves depending on the presence of TLE-related TVD.
Figure 2
Figure 2
Pulling-up of the tricuspid valve (TV) leaflet while removing the lead adhered to the tricuspid apparatus. (A) Fluoroscopy. Initial phase of the removal of the ventricular lead (yellow arrow) using the Byrd dilator (blue arrow). Visibly tense ventricular lead. Atrial lead (black arrow). (B) 2D transesophageal echocardiography (TEE), mid-esophageal view. Simultaneous TEE image. Pulled-up ventricular lead (yellow arrow) with uncontrolled pulling of the septal leaflet of the TV (green arrow) lead adhesions to the septum (red arrow). (C,C1) 2D TEE, middle and low esophageal views. The next steps in removing the adherent to the posterior TV leaflet (green arrow) of the ventricular lead (yellow arrow). (C1) Winding of the leaflet (green arrow) on the dilator (blue arrow).
Figure 3
Figure 3
Winding of the leaflet on the dilatator while removing the ventricular lead (simultaneous images from fluoroscopy and transesophageal echocardiography (TEE). (A,A1) Tight ventricular lead (red arrow) and Byrd’s dilatator (blue arrow) winding the valve leaflets. (B,B1) When rotating the dilator in one direction (blue arrow), winding of the tricuspid valve (TV) leaflet and the attached atrial lead (yellow arrow) occurred (as a result of adhesions of the lead with the leaflet and inter-lead adhesions).
Figure 4
Figure 4
Adhesion of the lead to the tricuspid apparatus. Broken chordae tendineae during transvenous lead extraction (TLE). (A) 2D transesophageal echocardiography (TEE) transgastric view, color Doppler. The ventricular lead (yellow arrow) is fused with the posterior leaflet (red arrow) and the subvalvular apparatus. Papillary muscles (blue arrows). Low tricuspid regurgitation. (B) 3D TEE. Tricuspid valve (TV) view from the right ventricle (RV) side. Tissue bridges (adhesions) (red arrows) connecting the ventricular lead (dashed line) with the posterior leaflet (PTL). (C) 2D TEE transgastric view. Broken chordae tendineae (circle) that moves to right atrium (RA) (D) 2D TEE transgastric view. Image from panel C in the option of color Doppler, large TR to RA, Vena contracta (VC) = 11 mm (black arrow).
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