Outcomes of video‐assisted thoracoscopic surgery for transvenous lead extraction

Introduction To evaluate the outcomes of video‐assisted thoracoscopic surgery (VATS) during transvenous lead extractions (TLEs). Methods and results Ninety‐one high‐risk patients who underwent TLE in the operating room from January 1, 2015, to March 31, 2017, were included in the study. Of these, 9 patients underwent VATS during TLE. Their clinical characteristics, indications for lead extraction, and complications associated with TLE in the 9 patients who had VATS were compared with those for the 82 patients who did not have VATS. The mean (SD) age of the study patients was 61 (17) years (64.8% were male). The lead dwell time, number of leads extracted, and clinical comorbidities were similar between the 2 groups. Superior vena cava (SVC) tear occurred in 2 of the 9 patients in VATS group and in 1 of the 82 in the non‐VATS group (22.2% vs. 1.2%, P = 0.03). Of the 2 patients in the VATS group who had SVC tears, in 1 the tear was visualized immediately and there was no hemodynamic compromise. In the other patient, the SVC tear was within the pericardium; the blood pressure recovered quickly after sternotomy and repair. Both patients had complete lead extraction and survived hospitalization. The patient in the non‐VATS group who had an SVC tear had a successful repair but died of postoperative complications. Conclusions Utilization of VATS to facilitate TLE is beneficial for early recognition of SVC tear and timely surgical repair in select high‐risk patients.