Surgical Outcomes and complications from Transvenous Laser lead Extractions
Lindsay Volk, Nina Verghis, Hirohisa Ikegami, Mark Russo, Leonard Lee, Anthony Lemaire.
Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
There has been an increase in the number of cardiac implantable devices and consequently, there has also been a need for more extractions of older leads. Cardiothoracic surgeons have provided emergency backup for lead extractions. The purpose of the study is to evaluate the surgical outcomes of patients undergoing transvenous laser lead extractions.
A retrospective chart review of consecutive patients undergoing laser lead extractions at a single academic center. Lead extractions using only laser sheaths were analyzed. The clinical characteristics, complications, and mortality of the patients were evaluated.
A total of 121 consecutive patients underwent laser lead extractions from January 1st 2014 to December 31st 2018. The majority of the patients were male (N=80), and the average age was 66.48±14. A total of 2 patients (1.6%) had injuries that required emergency sternotomies and required cardiopulmonary bypass for surgical repair. The posterior superior vena cava and right ventricle were injured in the two cases. Both patients survived the initial injury with one patient being discharged home on day #4 and 1 patient succumbing to his injuries on postoperative day #20. The indication for removal was either laser lead malfunction or infection. A total of 30 patients (2.4%) had complications postoperatively that included (1) wound hematomas, (2) superficial infections, and (3) arrythmias. The average length of stay was 9±12 for all the patients in the study.
Although the incidence of surgical emergencies is rare, the morbidity and mortality require that surgical backup be available for laser lead extractions.
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